How safe is catheter ablation of atrial fibrillation in patients 65 years or older?

October 6, 2012

This was a retrospective analysis of the US Centers for Medicare and Medicaid Services database, by Piccini et al (published in Circulation 2012; Sep 26).
All patients 65 years or older who underwent CA of AF in 2007-2009 were included. The sample size was 15,423 patients, with a mean age of 72 years. Outcomes were tracked for 1 year post-CA.

The mortality rate at 30 days was 0.8%. The 30-day rates of post procedure events were as follows: myocardial infarction (0.3%), pericardial effusion (1.7%), stroke (0.8%), and vascular complications requiring surgery (0.5%).
The mortality rate at 1 year was 3.8%. The 1-year rates of events were as follow: heart failure (2.5%), stroke (2.1%), hospitalization (43%), and repeat CA (11%).
Renal impairment, age >80 years, and heart failure were independent risk factors for death at 1 year.
The mortality rate was 5 times higher in patients older than 80 years than in patients 69 years or younger. Older age independently was predictive of all major complications.
The overall risk of death and major complications after CA of AF is relatively low in Medicare beneficiaries, but the risk increases with advanced age. The redo CA rate of only 11% is considerably lower than the atrial fibrillation recurrence rate.


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