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Heart, Lung and Circulation

Evaluation of Safety and Effectiveness of Catheter Ablation of Atrial Fibrillation in Patients Aged ≥80 Years

  • Yuan-yuan Liu
    Affiliations
    Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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  • Xin Du
    Affiliations
    Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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  • Liu He
    Affiliations
    Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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  • Tong Liu
    Affiliations
    Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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  • Ning Chen
    Affiliations
    Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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  • Rong Hu
    Affiliations
    Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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  • Man Ning
    Affiliations
    Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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  • Qiang Lv
    Affiliations
    Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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  • Jian-zeng Dong
    Affiliations
    Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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  • Chang-sheng Ma
    Correspondence
    Corresponding author at: Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, No 2. Anzhen Road, Chaoyang District, Beijing 100029, China
    Affiliations
    Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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Published:March 15, 2022DOI:https://doi.org/10.1016/j.hlc.2022.02.003

      Aims

      The prevalence and incidence of atrial fibrillation (AF) significantly increase with age. Catheter ablation is already recommended in the guidelines for this selected elderly population. This study aimed to explore the safety and effectiveness of AF catheter ablation in patients aged ≥80 years.

      Methods

      The data were based on the China-AF study. Patients with AF aged ≥80 years who received catheter ablation from August 2011 to December 2020 were selected. Catheter ablation included bilateral circumferential pulmonary vein antrum isolation with or without additional linear ablation. Patients were followed up every 6 months. Arrhythmia-free curves were generated using Kaplan-Meier analysis. Cox proportional hazards regression models were used to analyse the predictors for post-ablation recurrence.

      Results

      A total of 270 patients were included in the study. Many patients had comorbidities: 73.7% had hypertension and 29.3% had diabetes mellitus. All patients achieved successful bilateral circumferential pulmonary vein antrum isolation. Total complications were noted in nine of 270 (3.3%) patients and nine of 286 (3.1%) ablation procedures. After the first ablation procedure, 74% of the whole cohort—78% patients with paroxysmal AF, and 66% patients with persistent AF – were free from atrial tachyarrhythmia at follow-up to 12 months. Patients with persistent AF, longer AF duration, and history of ischaemic stroke were more likely to have AF recurrence.

      Conclusion

      Patients with AF aged ≥80 years, although with many comorbidities, had low complication rates and favourable outcomes after catheter ablation. Catheter ablation was a safe and effective treatment to achieve sinus rhythm in the selected elderly patients.

      Keywords

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      References

        • Chugh S.S.
        • Havmoeller R.
        • Narayanan K.
        • Singh D.
        • Rienstra M.
        • Benjamin E.J.
        • et al.
        Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study.
        Circulation. 2014; 129: 837
        • Guo Y.
        • Tian Y.
        • Wang H.
        • Si Q.
        • Wang Y.
        • Lip G.Y.H.
        Prevalence, incidence and lifetime risk of atrial fibrillation in China: new insights into the global burden of atrial fibrillation.
        Chest. 2015; 147: 10
        • Go A.S.
        • Hylek E.M.
        • Phillips K.A.
        • Chang Y.
        • Henault L.E.
        • Selby J.V.
        • et al.
        Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study.
        JAMA. 2001; 285: 2370-2375
        • Heeringa J.
        • van der Kuip D.A.
        • Hofman A.
        • Kors J.A.
        • van Herpen G.
        • Stricker B.H.
        • et al.
        Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study.
        Eur Heart J. 2006; 27: 949-953
        • Hindricks G.
        • Potpara T.
        • Dagres N.
        • Arbelo E.
        • Bax J.J.
        • Blomström-Lundqvist C.
        • et al.
        2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS).
        Eur Heart J. 2021; 42: 373-498
        • Santangeli P.
        • Di Biase L.
        • Mohanty P.
        • Burkhardt J.D.
        • Horton R.
        • Bai R.
        • et al.
        Catheter ablation of atrial fibrillation in octogenarians: safety and outcomes.
        J Cardiovasc Electrophysiol. 2012; 23: 687-693
        • Bulava A.
        • Hanis J.
        • Dusek L.
        Clinical outcomes of radiofrequency catheter ablation of atrial fibrillation in octogenarians-10-year experience of a one high-volume center.
        J Geriatr Cardiol. 2017; 14: 575-581
        • Bunch T.J.
        • Weiss J.P.
        • Crandall B.G.
        • May H.T.
        • Bair T.L.
        • Osborn J.S.
        • et al.
        Long-term clinical efficacy and risk of catheter ablation for atrial fibrillation in octogenarians.
        Pacing Clin Electrophysiol. 2010; 33: 146-152
        • Tan H.W.
        • Wang X.H.
        • Shi H.F.
        • Yang G.S.
        • Zhou L.
        • Gu J.N.
        • et al.
        Efficacy, safety and outcome of catheter ablation for atrial fibrillation in octogenarians.
        Int J Cardiol. 2010; 145: 147-148
        • Zado E.
        • Callans D.J.
        • Riley M.
        • Hutchinson M.
        • Garcia F.
        • Bala R.
        • et al.
        Long-term clinical efficacy and risk of catheter ablation for atrial fibrillation in the elderly.
        J Cardiovasc Electrophysiol. 2008; 19: 621-626
        • Metzner I.
        • Wissner E.
        • Tilz R.R.
        • Rillig A.
        • Mathew S.
        • Schmidt B.
        • et al.
        Ablation of atrial fibrillation in patients ≥75 years: long-term clinical outcome and safety.
        Europace. 2016; 18: 543-549
        • Du X.
        • Ma C.
        • Wu J.
        • Ning M.
        • Tang R.
        • Guo X.
        • et al.
        Rationale and design of the Chinese Atrial Fibrillation Registry Study.
        BMC Cardiovasc Disord. 2016; 16: 130
        • Lip G.Y.
        • Nieuwlaat R.
        • Pisters R.
        • Lane D.A.
        • Crijns H.J.
        Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on atrial fibrillation.
        Chest. 2010; 137: 263-272
        • Calkins H.
        • Hindricks G.
        • Cappato R.
        • Kim Y.H.
        • Saad E.B.
        • Aguinaga L.
        • et al.
        2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation.
        Europace. 2018; 20: e1-e160
        • Dong J.Z.
        • Sang C.H.
        • Yu R.H.
        • Long D.Y.
        • Tang R.B.
        • Jiang C.X.
        • et al.
        Prospective randomized comparison between a fixed '2C3L' approach vs stepwise approach for catheter ablation of persistent atrial fibrillation.
        Europace. 2015; 17: 1798-1806
        • Camm A.J.
        • Kirchhof P.
        • Lip G.Y.
        • Schotten U.
        • et al.
        • European Heart Rhythm A, European Association for Cardio-Thoracic S
        Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC).
        Eur Heart J. 2010; 31: 2369-2429
        • January C.T.
        • Wann L.S.
        • Alpert J.S.
        • Calkins H.
        • Cigarroa J.E.
        • Cleveland J.C.
        • et al.
        2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society.
        J Am Coll Cardiol. 2014; 64: e1-e76
        • Wilber D.J.
        • Pappone C.
        • Neuzil P.
        • De Paola A.
        • Marchlinski F.
        • Natale A.
        • et al.
        AF Trial Investigators: Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: A randomized controlled trial.
        JAMA. 2010; 303: 333-340
        • Wazni O.M.
        • Marrouche N.F.
        • Martin D.O.
        • Verma A.
        • Bhargava M.
        • Saliba W.
        • et al.
        Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: A randomized trial.
        JAMA. 2005; 293: 2634-2640
        • Jais P.
        • Cauchemez B.
        • Macle L.
        • Daoud E.
        • Khairy P.
        • Subbiah R.
        • et al.
        Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: The A4 study.
        Circulation. 2008; 118: 2498-2505
        • Hsieh M.H.
        • Tai C.T.
        • Lee S.H.
        • Tsao H.M.
        • Lin Y.K.
        • Huang J.L.
        • et al.
        Catheter ablation of atrial fibrillation versus atrioventricular junction ablation plus pacing therapy for elderly patients with medically refractory paroxysmal atrial fibrillation.
        J Cardiovasc Electrophysiol. 2005; 16: 457-461
        • Corrado A.
        • Patel D.
        • Riedlbauchova L.
        • Fahmy T.S.
        • Themistoclakis S.
        • Bonso A.
        • et al.
        Efficacy, safety, and outcome of atrial fibrillation ablation in septuagenarians.
        J Cardiovasc Electrophysiol. 2008; 19: 807-811
        • Spragg D.D.
        • Dalal D.
        • Cheema A.
        • Scherr D.
        • Chilukuri K.
        • Cheng A.
        • et al.
        Complications of catheter ablation for atrial fibrillation: Incidence and predictors.
        J Cardiovasc Electrophysiol. 2008; 19: 627-631
        • Hsu L.F.
        • Jais P.
        • Sanders P.
        • Hocini M.
        • Sacher F.
        • Takahashi A.
        • et al.
        Catheter ablation of permanent atrial fibrillation in the elderly.
        Heart Rhythm. 2005; 2: S313-S314
        • Kundi H.
        • Noseworthy P.A.
        • Valsdottir L.R.
        • Shen C.
        • Yao X.
        • Yeh R.W.
        • et al.
        Relation of frailty to outcomes after catheter ablation of atrial fibrillation.
        Am J Cardiol. 2020; 125: 1317-1323