Observational studies show that catheter ablation is safe and effective in both young and elderly patients with atrial fibrillation.
CABANA (Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation) study patients, age ≥ 65 years, or age < 65 years with ≥ 1 Stroke risk factors were randomized to catheter ablation versus medical therapy. Primary endpoint: composite of death, disabling stroke, major bleeding, or cardiac arrest. Secondary endpoints included a composite of all-cause death, death or cardiac hospitalization, and recurrence of atrial fibrillation.
2204 patients, 766 (34.8%) aged <65 years, 1130 (51.3%) 65-74 years old, 308 patients (14%) ≥75 years old. Catheter ablation reduced the primary end point event rate: 43% in the <65-year group (aHR, 0.57, 95% CI, 0.30-1.09); 21% in the 65-74-year group (aHR, 0.79; 95% CI, 0.54-1.16) ; the effect in the ≥75-year-old group was uncertain (aHR, 1.39; 95% CI, 0.75–2.58). The 4-year event rates for ablation vs medical therapy were 3.2% vs 7.8%, 7.8% vs 9.6%, and 14.8% vs 9.0%, respectively. For each additional 10 years, the primary end point, aHR (decrease in the effect of ablation) increased by a mean of 27%.
A similar pattern was observed for all-cause mortality, with a mean increase of 46% in aHR for each additional 10 years. Atrial fibrillation recurrence rate was lower in each age group with ablation than in the medical treatment group, with aHR distributions of 0.47, 0.58 and 0.49. Treatment-related complications were uncommon in all age groups.
The benefit of catheter ablation varied in different age groups, with the absolute and relative benefit being greatest in the younger group. No prognostic benefit of catheter ablation was observed in persons aged ≥75 years.
Baseline characteristics are shown in the table below,
The relationship between the primary endpoint and age is shown in the figure below.
The 4-year event rate comparison for different age groups is shown in the figure below,
Total deaths vs. The age relationship is shown in the figure below,
Circulation. 2022;145:796–804.