ABSTRACT
BACKGROUND: The benefits of catheter ablation for elderly patients with atrial fibrillation (AF) with respect to mortality and stroke reductions remain unclear. OBJECTIVE: The purpose of this study was to evaluate the safety and efficacy, including long-term outcomes, of catheter ablation for maintaining normal sinus rhythm (NSR) in elderly patients with AF. METHODS: We evaluated 587 elderly patients (age ≥75 years) with AF. Of the 324 who were eligible for ablation, 261 (group 1) underwent ablation guided by complex fractionated atrial electrogram. The remaining 63 patients (group 2) either declined or were not suitable for ablation. The end-points were NSR, stroke, death, and major bleeding. RESULTS: Two hundred sixteen patients (83%) remained in NSR compared to only 14 group 2 patients (22%; mean follow-up 3 ± 2.5 years, P <.001). The 1- and 5-year survival rates for group 1 with NSR, group 1 with AF, and group 2 patients were 98% and 87%, 86% and 52%, and 97% and 42%, respectively (P <.0001). NSR was an independent favorable parameter for survival (hazard ratio [HR] 0.36; 95% CI, 0.02-0.63, p = 0.0005), whereas older age (HR 1.09, 95% CI 1.01-1.16, P = .02) and depressed ejection fraction <40% (HR 2.38, 95% CI 1.28-4.4, P = .006) were unfavorable. Warfarin therapy was discontinued in 169 of the 216 group 1 patients (78%) who maintained NSR and had only 3% 5-year stroke/bleeding rates compared to 16% in group 2 (P <.001). CONCLUSION: Elderly patients with AF benefit from AF ablation, which is safe and effective in maintaining sinus rhythm and is associated with lower mortality and stroke risks.
Subject(s)
Atrial Fibrillation/surgery , Catheter Ablation/adverse effects , Age Factors , Aged , Aged, 80 and over , Anti-Arrhythmia Agents/therapeutic use , Anticoagulants/therapeutic use , Atrial Fibrillation/complications , Atrial Fibrillation/mortality , Female , Follow-Up Studies , Humans , Male , Retrospective Studies , Risk Assessment , Stroke/epidemiology , Stroke/prevention & control , Survival Rate , Treatment OutcomeABSTRACT
OBJECTIVES: The purpose of this study was to determine the long-term clinical outcomes of catheter ablation of atrial fibrillation (AF) substrate for high-risk patients with AF. BACKGROUND: The benefits of catheter ablation for high-risk AF patients with respect to mortality and stroke reductions remain unclear. METHODS: We performed AF substrate ablation guided by complex fractionated atrial electrogram (CFAE) mapping in 674 high-risk AF patients. The clinical end points were sinus rhythm (SR), death, stroke, or bleeding. Of these 674 patients, 635 were available for follow-up and made up the study cohort. The patients were relatively old (mean age 67 +/- 12 years) and 129 had an ejection fraction (EF) <40%. RESULTS: After the mean follow-up period of 836 +/- 605 days, 517 were in SR (81.4%). There were 15 deaths among the patients who stayed in SR compared with 14 deaths among those who remained in AF (5-year survival rate, 92% vs. 64%, respectively; p < 0.0001). SR was the most important independent favorable parameter for survival (hazard ratio 0.14, 95% confidence interval 0.06 to 0.36, p < 0.0001), whereas old age was unfavorable. Warfarin therapy was discontinued in 434 of the 517 patients in SR post-ablation (84%) whose annual stroke rate was only 0.4% compared with 2% in those with continuing warfarin treatment (p = 0.004). CONCLUSIONS: CFAE-targeted ablation of AF is effective in maintaining SR in selected high-risk AF patients and might allow patients to stop warfarin therapy. SR after AF ablation is a marker of relatively low mortality and stroke risk. Our findings support conducting further randomized studies to determine whether AF ablation is associated with mortality and/or stroke reduction.
