Clinical outcomes after catheter ablation for atrial fibrillation in elderly patients: a meta-analysis with time-to-event data reconstruction.
Ali Saad Al-Shammari, Ahmed Mazen Amin, Ameer Awashra et al.
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In 30 seconds
This systematic review and meta-analysis compared long-term outcomes after catheter ablation for atrial fibrillation in elderly and non-elderly patients, drawing on 28 studies involving 22,921 patients. Elderly patients had a higher risk of AF recurrence (RR 1.174, 95% CI 1.068-1.290; P < 0.001), a finding also supported by reconstructed time-to-event analysis (HR 1.138, 95% CI 1.055-1.227; P = 0.001). The analysis also found higher risks of all-cause mortality, stroke, and several procedural complications in elderly patients.
Key findings
- AF recurrence was more frequent in elderly patients (RR 1.174, 95% CI 1.068-1.290; P < 0.001).
- Reconstructed time-to-event analysis also showed higher recurrence risk (HR 1.138, 95% CI 1.055-1.227; P = 0.001).
- Elderly patients had higher risks of all-cause mortality (RR 3.978, 95% CI 2.852-5.547; P < 0.001) and stroke (RR 2.136, 95% CI 1.336-3.414; P = 0.002).
- Risks of hemopericardium/tamponade, atrioesophageal fistula, and pulmonary vein stenosis were also higher in elderly patients.
Why it matters
The findings indicate that age is associated with differences in both efficacy and safety after AF ablation. Considering recurrence alongside mortality, stroke, and procedural complications can help frame discussions about expected outcomes and the balance of potential benefits and harms. The results support careful, individualized assessment rather than assuming outcomes are equivalent across age groups.
What to keep in mind
The meta-analysis combined comparative studies, and reconstructed time-to-event data were derived from Kaplan-Meier curves rather than individual patient records. The abstract does not report the underlying studies’ designs or follow-up durations.