The following is a summary of “OUTCOMES OF ATRIAL FIBRILLATION ABLATION IN OCTOGENARIANS,” published in the March 2023 issue of Cardiology by Adabale, et al.
There was a paucity of in-hospital outcome data on the benefits of atrial fibrillation (AF) ablation in elderly patients. For a study, researchers sought to investigate the in-hospital outcomes of AF ablation in patients aged ≥80 years or older (octogenarians) compared to patients aged 65-79.
Using the International Classification of Diseases clinical procedural codes, the National Inpatient Sample database was searched for all hospitalization records of patients aged ≥ 65 years who were electively hospitalized for the primary procedure of AF ablation from 2012 to 2017. Baseline continuous variables were compared between octogenarians and the 65-79 age group using nonparametric tests and inter-quarter ranges with the Wilcoxon rank test. The primary outcome was all-cause mortality and major adverse cardiovascular events (MACE), a composite of death, stroke, myocardial infarction (MI), or cardiogenic shock. Secondary outcomes included stroke, MI, cardiogenic shock, respiratory failure, pacemaker insertion, acute kidney injury (AKI), vascular complications, bleeding, length of stay (LOS), and hospitalization cost.
Of the 45,050 patients included in the study, 6,100 were octogenarians, and 39,950 were aged ≥ 80 years. Octogenarians were more likely to be male and had a higher prevalence of baseline anemia, hypothyroidism, and chronic kidney disease. In univariate analysis, octogenarians had higher rates of mortality (0.9% vs 0.4%), AKI (9.1% vs 5.6%), pacemaker insertion (6.5% vs 1.8%), and prolonged hospital stay. In multivariable analysis, there was no difference in mortality and MACE between the groups. However, octogenarians had a significantly higher risk for AKI (adjusted OR 1.37 [95% CI: 1.06 – 1.76] P=0.017) and pacemaker insertion (OR 3.45 [95%CI: 2.58 – 4.60] P<0.001). Additionally, they had a 15% increase in LOS.
Octogenarians have a similar adjusted risk of in-hospital mortality and MACE as adults aged 65-79 but a higher risk of pacemaker insertion and AKI after AF ablation. Considering the limited prognostic benefits, decisions to pursue AF ablation in this patient population should be carefully assessed.