Aim: A recent prospective study in elderly patients with persistent AF found better efficacy in maintaining sinus rhythm with ablation versus anti-arrhythmic drugs (AAD), higher probability for discontinuing drugs with ablation, thus less adverse events and greater improvement in quality of life. However, the ablation group had higher acute complication rate, especially stroke. We compared our experience with AF ablation in elderly vs. a younger group of patients.
Methods and results: We studied prospectively all consecutive patients who underwent AF ablation in our center between 7/2011- 11/2013 and compared (available data) the older group of patients (≥70y, n=42) versus the younger group (n=130) regarding safety and efficacy of the procedure. The older group (range 70-81y, 74 ± 3y; 55% male, 24% persistent AF; 12% redo procedures) underwent AF ablation using PVAC® (n=27), nMARQ™ (n=11), irrigated tip-CARTO (n=3) and Cryo balloon (n=1). The younger group (range 26-69y, 58 ± 8y; 66% male, 19% persistent AF; 11% redo) underwent AF ablation using PVAC® (n=85), nMARQ™ (n=35), irrigated tip-CARTO/Ensite (n=7) and Cryo balloon (n=3). Complication rates in the older vs the younger groups were: tamponade in 0/42 (0%) vs. 2/130 (1.5%); pseudoaneurysm in 1/42 (2.3%) vs. 7/130 (5.3%); and transient ST elevation in 1/42 (2.3%) vs. 7/130 (5.35%), respectively. Neither ablation was complicated by stroke. 3, 6 & 12 months freedom from AF were: 27/32 (84%), 15/19 (79%), and 11/15 (73%) for the elderly group. 20/32 (62%) discontinued AAD, 3 (7%) were referred for redo procedure, and 1 for pacemaker and AVN ablation. For the younger group- 3, 6 & 12 months freedom from AF were: 79/96 (82%), 44/54 (82%), and 29/35 (83%). 48/96 (50%) discontinued AAD, 13 (10%) were referred for redo procedure, and 1 for pacemaker and AVN ablation.
Conclusions: Our data show that AF ablation is as safe and effective for the elderly as for the younger patients. Further randomized studies are warranted to verify this conclusion.
