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Atrial Fibrillation (AF) affects approximately 2 million people in the United States alone. The prevalence of AF increases with age and is 9% at > 80 years, compared to < 0.1% at < 55 years of age. The elderly pose increased difficulties in management due to concurrent cardiovascular disease, age-related physiologic changes that increase drug toxicities and interactions. Use of catheter AF ablation in the elderly is not widespread, and there remains a lack of long-term studies in older age groups specifically examining ablative approaches to AF therapy.
There is a general sense that elderly patients are at increased risk for thromboembolic complications such as stroke, and myocardial perforations. This has led to suggestions by the Atrial Fibrillation Ablation Consensus that age should be considered when determining ablation candidacy. Outcome based data in elderly patients is sparse, especially in the group of octogenarians. In order to determine the effect of ablation on octogenarians, the researchers examined catheter ablation in a wide spectrum of AF patients, and used age-based comparison to obtain outcome data. In a prospective study 752 patients were treated for their AF with catheter ablations, including 35 older than 80.
All patients underwent Pulmonary Vein isolation and complete antral isolation with radiofrequency ablation resulting in loss of all local atrial electrograms (ensuring electrical block), with or without additional ablative lines. Additionally a cavo-tricuspid isthmus ablation was performed in all patients. Sinus rhythm was restored in all patients by the end of the procedure, using transthoracic cardioversion if necessary.
Follow up was obtained for 12 months using multiple modalities to determine recurrence of symptomatic or asymptomatic episodes of AF. Analysis of outcomes showed no significant difference in risk of stroke, vascular injury, or perforation in octogenarians. There was also no significant difference in 1-year survival free of AF or flutter. This data suggests that elderly patients including octogenarians have satisfactory rhythm management using catheter ablation for AF. Importantly, procedure risk associated with radiofrequency ablation did not increase with patient’s age.
The authors concluded that, “These findings represent important supportive data on the validity and safety of this therapeutic approach as it becomes generalized to a broader population” (Bunch et al. Long-Term Clinical Efficacy and Risk of Catheter Ablation for Atrial Fibrillation in Octogenarians. Pacing Clin Electrophysiol 2010;33:146-152)
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