Objective: We aimed to investigate the temporal trends of first-time ablations in the elderly, the impact of age on major adverse cardiovascular events (MACE), and a composite endpoint of AF-related hospitalizations, repeat AF ablation, or use of antiarrhythmic drugs (AADs).

Background: The elderly population with atrial fibrillation (AF) is growing. There is limited evidence to suggest AF ablation as an effective treatment for the elderly.

Methods: Utilizing the Danish administrative registers, we incorporated individuals undergoing their first-time AF ablation from 2001 to 2020. Our cohort was divided into three age groups (<60 years, 60-74 years, ≥75 years) and scrutinized across four consecutive 5-year intervals. Cox proportional-hazard multivariable analyses and cumulative incidences were used to evaluate the endpoints of 5-year MACE incidence and a 1-year composite endpoint of AF-related hospitalizations, repeat AF ablation, or use of antiarrhythmic drugs.

Results: Elderly patients who underwent AF ablation increased significantly, from none in 2001 to 9% in 2020. The 5-year incidence of MACE in the elderly decreased from 61.9% (95%CI 41.1% - 82.7%) to 38.1% (95%CI 31.9% - 44.2%). The hazard ratio for age ≥75 years in the last time period was 1.52 (95%CI 1.26 - 1.83). The 1-year composite outcome varied from 35.6 to 52.0%, age was not a consistent predictor.

Conclusions: AF ablation use in the elderly has significantly increased over time. A notable decrease in MACE was evident across all age cohorts, with a particularly pronounced trend observed among the elderly population. Age was not an independent predictor of the composite endpoint. 

Editor-in-Chief
Kalyanam Shivkumar, MD, PhD, FACC
 
CME Editor
Kenneth A. Ellenbogen, MD, FACC

Author
Kelvin N.V. Bush, MD, FACC


Important Dates
Date of Release: January 27, 2025
Term of Approval/Date of CME/MOC Expiration: January 26, 2026