Assessment of the safety and efficacy of catheter ablation for atrial fibrillation in very elderly patients: insight from the national prospective registry study.

Background and aims: This study evaluated the safety and efficacy of catheter ablation in treating atrial fibrillation (AF) among the elderly population.

Methods and results: A total of 170 017 AF ablation procedures prospectively enrolled from 482 facilities between 2017 and 2020 were analysed. They were stratified into six age groups, ranging from <65 to ≥85 years, in 5-year increments. A cut-off of 80 years was set for dividing participants into two groups. The primary endpoints included procedure-related complications and 1-year arrhythmia recurrence after a 3-month blanking period. Patients ≥80 years constituted 7.2% of procedures in 2017, which significantly increased to 9.6% by 2020 (P < 0.001). This older group predominantly comprised women with smaller stature and body mass index, a higher prevalence of paroxysmal AF, and a higher rate of initial ablation procedures. The overall complication rate was 2.8%, showing a positive correlation with age (P < 0.001), peaking at 4.3% for patients ≥85 years. Older age remained a significant independent risk factor for complications (odds ratio: 1.36 [1.24, 1.49], P < 0.001). Cardiac tamponade, ischaemic stroke, and sick sinus syndrome were more common in the elderly. The recurrence rate in the total population was 16.0% and did not differ significantly between age groups (log-rank P = 0.473), remaining consistent even after adjusting for multiple variables.

Conclusion: Although age increases complication risk, recurrence rates remained steady across age groups, suggesting that AF ablation is a reasonable option for elderly individuals, contingent on careful patient selection for safety.