Abstract 2315: Elderly Patients Experience an Equal Clinical Efficacy With No Observed Increase in Complications From More Aggressive Left Atrial Ablation
Background: An aging population coupled with more patients living longer with cardiovascular disease have resulted in a dramatic increasing prevalence of elderly patients with atrial fibrillation (AF). The long-term efficacy from left atrial ablation for AF is favorable in the elderly. However, it remains unclear if the procedure should be modified in the elderly and a less aggressive approach used to minimize periprocedural and long-term complications.
Methods: Over a 3 year period, 711 consecutive patients underwent either wide area circumferential ablation (WACA) or WACA plus additional linear lines in the left atrium (WACA-L) for drug refractory AF. Outcome analysis based on ablation type, was partitioned into age-based tertiles for comparison (<55 years: WACA n=20, WACA-L n=93, 55–75 years: WACA n=112, WACA-L n=380, >75 years WACA n=21, WACA-L n=85).
Results: In general, those patients that underwent a more aggressive approach were older (66±10 vs. 62±12, p<0.0001), had higher rates of heart failure (13.7% vs. 1.5%, p<0.0001), lower rates of paroxysmal AF (45.5% vs. 77.0%, p<0.0001), and higher levels of BNP [263 (124 – 495) vs. 106 (48 –202) pg/nl, p<0.0001). 1-year survival free AF rates were similar and independent of procedure type across age age-groups [age<55 years: 78.9% (WACA) vs. 85.9% WACA-L, p=0.51), age 55–75: 85.2% (WACA) vs. 80.5% (WACA-L, p=0.04), 81.2% (WACA) vs. 83.7% (WACA-L, p=0.98). No significant increases in periprocedural complications were found relative to ablation strategy or age. Specifically, there were 10 (1.4%) perforations that were spread across all groups and 2 developed pulmonary vein stenosis (1 age <55, 1 age >75). Long-term there were 5 deaths (4, 55–75, 1>75 years) that were >90 days from the procedure and 4 strokes (1 <55, 2 55–75, 1 >75 years).
Conclusions: These data support both the use of WACA and WACA-L as strategies for management of AF in all age groups. Furthermore, there is no increased risk if WACA-L is used in the elderly. This decision approach should be made based upon AF subtype and coexistent disease rather than age alone.