Long term outcomes after catheter ablation of atrial fibrillation in the elderly: a systematic review and meta-analysis.

Abstract

Background: Current data on the outcomes and complications of catheter ablation of atrial fibrillation (AF) in elderly patients over 75 years is lacking. Methods: A systematic review was performed of retrospective and prospective studies of AF ablation outcomes in elderly patients. Search terms included “AF”, “catheter ablation”, “pulmonary vein isolation”, “recurrence”, “complications” in February 2019. Meta-analysis was performed using Stata ‘metaprop’. Data was extracted in patients over 75 years for arrhythmia-free survival at minimum 12 months follow-up. Results: Of 2142 studies on initial search, 8 studies met predefined inclusion criteria, with a total of 522 patients. Mean age was 80±3 years and follow-up was 25±15 months. At 12 months, single procedure freedom from AF ranged between 61-78% whilst multi-procedural success rates ranged from 59-87%. Meta-analysis of these studies produced a pooled overall success rate of 61% (44-78%), with heterogeneity between studies exceeding 50% (I2: 93.73%). Major complication rates were between 1-7%. Conclusion: AF ablation can be an effective treatment option in elderly patients with success rates comparable to studies in those below 75 years. While peri-procedural complications were overall low, careful patient selection is an important consideration prior to ablation.