The Impact of Age on 5‐Year Outcomes After Atrial Fibrillation Catheter Ablation

Bunch, T. Jared; May, Heidi T; Bair, Tami L; Jacobs, Victoria; Crandall, Brian G.; Cutler, Michael J.; Weiss, J. Peter; Mallender, Charles; Osborn, Jeffrey S.; Anderson, Jeffrey L.; Day, John D.

doi:10.1111/jce.12849

Cited by 69 publications

(53 citation statements)

References 17 publications

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“…Finally, age is a significant factor that is associated with disease progression in AF . Bunch et al reported that age was a significant factor in determining outcomes after catheter ablation for AF . Furthermore, Kosiuk et al with the DR‐FLASH score (diabetes mellitus, renal dysfunction, persistent form of AF, left atrial diameter > 45 mm, age > 65 years, female sex, and hypertension) and Letsas et al with the CHA 2 DS 2 ‐VASc score highlighted the importance of age as an independent predictor of arrhythmia recurrence after catheter ablation.…”

Section: Discussionmentioning

confidence: 99%

Predictors of arrhythmia recurrence in patients with heart failure undergoing left atrial ablation for atrial fibrillation

Bazoukis

Letsas

Tse

et al. 2018

Clinical Cardiology

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Background Atrial fibrillation (AF) ablation is increasingly used in patients with reduced left ventricular ejection fraction (LVEF). The aim of the present study was to evaluate the long‐term results of a single radiofrequency catheter ablation procedure in heart failure (HF) patients with AF. Hypothesis We tested the hypothesis that left atrial ablation is an effective therapeutic modality in patients with heart failure. Methods Our study included HF patients with LVEF <50% who underwent catheter ablation for AF at our department between January 2010 and March 2017. All patients underwent our institution's protocol for follow‐up post‐ablation. Results The study enrolled a total of 38 patients (mean age, 54.1 ± 12.2 years; 28 [73.7%] males; mean LVEF, 38.2% ± 6.3%). After a mean follow‐up period of 38.2 months (range, 5–92 months), 28 patients (73.7%) were free from arrhythmia recurrence. In multivariate analysis, early arrhythmia recurrence (P = 0.03) and amiodarone antiarrhythmic drug administration (P = 0.003) remained independent predictors of arrhythmia recurrence. Conclusions The main findings of this study are that (1) a single radiofrequency catheter ablation procedure is an effective and safe modality for AF in patients with concomitant HF; (2) after a mean 3.3 years of follow‐up, 73.7% of HF patients remained in sinus rhythm; and (3) early arrhythmia recurrence was a significant predictor of arrhythmia recurrence after the blanking period.

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Section: Discussionmentioning

confidence: 99%

Predictors of arrhythmia recurrence in patients with heart failure undergoing left atrial ablation for atrial fibrillation

Bazoukis

Letsas

Tse

et al. 2018

Clinical Cardiology

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“…Risk of thromboembolism may persist in the elderly population over 75 years of age undergoing AF ablation regardless of whether sinus rhythm is apparently maintained . A number of studies that have specifically focused on reporting the outcomes of AF ablation in older individuals and several randomized trials have included patients who were >75 years of age . The results of these studies provide evidence that catheter ablation of AF has an acceptable safety and efficacy profile in the elderly over the age of 75 or 80 years.…”

Section: Choice Of Rate Vs Rhythm Control In Elderly Af Patientsmentioning

confidence: 99%

“…The results of these studies provide evidence that catheter ablation of AF has an acceptable safety and efficacy profile in the elderly over the age of 75 or 80 years. Age has the significant impact on the long‐term outcomes of AF ablation; for every 10‐year increase in age, there was a higher multivariate‐adjusted risk of AF recurrence, death, and major cardiac events . Furthermore, the complications of the procedure are somewhat increased in older individuals, the need for concomitant antiarrhythmic therapy postablation is greater, and the efficacy is somewhat reduced .…”

Section: Choice Of Rate Vs Rhythm Control In Elderly Af Patientsmentioning

confidence: 99%

Atrial fibrillation in aging population

Chen¹,

Cheng³

2018

Aging Medicine

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With aging, the pathogenesis processes of atrial fibrillation (AF) are heightened. In this article, we review the mechanisms that predispose elderly patients to AF. We also highlight the unique features in diagnosis, stroke prevention, and treatment strategies for the elderly patient with AF. K E Y W O R D Saging, arrhythmia, atrial fibrillation 1 | BACKGROUND Atrial fibrillation (AF) is one of the most common diseases in elderly patients, and its prevalence increases with age. 1 The prevalence is estimated to be 0.3% in subjects of 40 years old, 5%-9% in those between 60 and 80 years old, and approximately 10% of patients more than 80 years old. 2 There are two primary factors that contribute to the high prevalence of AF in the elderly, the degenerative changes of the aging heart itself and the accompanying structural heart and systemic diseases, most notably coronary artery disease and hypertension, whose incidences increase cumulatively over one's life. | ATRIAL REMODE LIN G IN AGING HEARTSThe pathogenesis processes of AF are heightened by aging. The incidence of comorbidities such as ischemic heart disease and heart failure that are risk factors for AF is significantly increased in the elderly. Aging is associated with increased p-wave duration and dispersion, reflecting intra-atrial conduction abnormalities. Changes in p-wave morphology may herald the onset of AF. 3Atrial structural remodeling predisposes aged atria to AF. Progressive atrial fibrosis is a hallmark of aging heart. 4 Atrial fibrosis is known to occur as the result of aging-related changes in the cardiac collagen matrix and predisposes patients to AF. 5,6 Aging was identified as the most significant factor in atrial fibrogenesis (Figure 1). 7 An increase in fibrotic and a decrease in hypoxic signaling and microvessel density coupled with a differential expression of matrix metalloproteinases and tissue inhibitors of metalloproteinases that favors fibrosis may contribute to age-related atrial fibrogenesis. Cellular hypertrophy of atrial cardiomyocytes occurs as a compensatory response to aging-related loss or apoptosis of atrial cardiomyocytes. 8 Hypertrophic myocytes in the rat left atrium demonstrated an increased propensity to spontaneous Ca 2+ transients with a potential to generate triggered arrhythmias. 9Electrical remodeling is an important pathophysiological mechanism that promotes the progression from paroxysmal AF to permanent AF. The shortening of the atrial action potential duration (APD), and thereby the atrial effective refractory period (AERP), potentiates the pathogenesis of AF and underlies the progression of AF as "AF begets AF." 10 However, there have been conflicting data in agerelated changes in AERP although APD seems to be shortened with aging. 11-15 Such inconsistency in data could be a reflection of the heterogeneity in AERP distribution and nonlinear nature of the correlation between the APD and AERP, as well as the limited pacing sites and pacing cycle lengths.Although it is generally recognized that intra-atrial condu...

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“…Several retrospective cohort studies demonstrated that CA was safe and effective in maintaining sinus rhythm for elderly patients and associated with lower mortality and stroke risks. [ 8 9 ] The recent trial (AATAC-AF study) randomized patients with persistent AF and HF to AF ablation or treatment with amiodarone. The results showed that CA was more effective than amiodarone in preventing recurrent AF and was associated with a lower rate of hospitalization and mortality.…”

Section: Ndications and P Atient mentioning

confidence: 99%

Atrial Fibrillation Ablation

Guo

2017

Chinese Medical Journal

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The Impact of Age on 5‐Year Outcomes After Atrial Fibrillation Catheter Ablation

Abstract: Age significantly impacts outcomes after AF ablation when analyzed with long-term follow-up. These data highlight the progressive nature of AF and the need to consider interventions early.

Cited by 69 publications

References 17 publications

Predictors of arrhythmia recurrence in patients with heart failure undergoing left atrial ablation for atrial fibrillation

Predictors of arrhythmia recurrence in patients with heart failure undergoing left atrial ablation for atrial fibrillation

Atrial fibrillation in aging population

Atrial Fibrillation Ablation

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