Index and Repeat Ablation for Atrial Fibrillation in Older versus Younger Patients: A Propensity-Score Matching Analysis
Catheter ablation is a well-established rhythm control therapy in atrial fibrillation (AF). Although the prevalence of AF increases dramatically with age, the prognosis and safety profile of index and repeat ablation procedures remain unclear in the older population. The primary endpoint of this stu...
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| Veröffentlicht in: | Aging and disease 2024-02, Vol.15 (1), p.408-420 |
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| creator | Molina-Ramos, Ana Isabel Ruiz-Salas, Amalio Medina-Palomo, Carmen Becerra-Muñoz, Víctor Rodríguez-Capitán, Jorge Romero-Cuevas, Miguel Carmona-Segovia, Ada Fernández-Lozano, Ignacio Gómez-Doblas, Juan José Jiménez-Navarro, Manuel Pavón-Morón, Francisco Javier Barrera-Cordero, Alberto Alzueta-Rodríguez, Javier |
| description | Catheter ablation is a well-established rhythm control therapy in atrial fibrillation (AF). Although the prevalence of AF increases dramatically with age, the prognosis and safety profile of index and repeat ablation procedures remain unclear in the older population. The primary endpoint of this study was to assess the arrhythmia recurrence, reablation and complication rates in older patients. Secondary endpoints were the identification of independent predictors of arrhythmia recurrence and reablation, including information on pulmonary vein (PV) reconnection and other atrial foci. Older (n=129, ≥70 years) and younger (n=129, 0.999) rates after the index ablation. However, the reablation rate was significantly different (46.7% and 69.2%; p |
| doi_str_mv | 10.14336/AD.2023.0511 |
| format | Article |
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Although the prevalence of AF increases dramatically with age, the prognosis and safety profile of index and repeat ablation procedures remain unclear in the older population. The primary endpoint of this study was to assess the arrhythmia recurrence, reablation and complication rates in older patients. Secondary endpoints were the identification of independent predictors of arrhythmia recurrence and reablation, including information on pulmonary vein (PV) reconnection and other atrial foci. Older (n=129, ≥70 years) and younger (n=129, <70 years) patients were compared using a propensity-score matching analysis based on age, gender, obesity, hypertension, dyslipidemia, diabetes mellitus, dilated left atrium, severe obstructive sleep apnea, cardiac disease, left systolic ventricular function, AF pattern and ablation technique. Arrhythmia recurrence and reablation were evaluated in both groups using a Cox regression analysis in order to identify predictors. During a 30-month follow-up period, there were no significant differences between older and younger patients in the arrhythmia-free survival (65.1% and 59.7%; log-rank test p=0.403) and complication (10.1% and 10.9%; p>0.999) rates after the index ablation. However, the reablation rate was significantly different (46.7% and 69.2%; p<0.05, respectively). In those patients who underwent reablation procedure (redo subgroups), there were no differences in the incidence of PV reconnection (38.1% redo-older and 27.8% redo-younger patients; p=0.556). However, the redo-older patients had lower reconnected PVs per patient (p<0.01) and lower atrial foci (2.3 and 3.7; p<0.01) than the redo-younger patients. A further important finding was that age was not an independent predictor of arrhythmia recurrence or reablation. Our data reveal that the AF index ablation in older patients had a similar efficacy and safety profile to younger patients. Therefore, age alone must not be considered a prognostic factor for AF ablation but the presence of limiting factors such as frailty and multiple comorbidities.</description><identifier>ISSN: 2152-5250</identifier><identifier>EISSN: 2152-5250</identifier><identifier>DOI: 10.14336/AD.2023.0511</identifier><identifier>PMID: 37307839</identifier><language>eng</language><publisher>United States: JKL International LLC</publisher><subject>Aged ; Atrial Fibrillation - epidemiology ; Catheter Ablation - adverse effects ; Heart Atria ; Humans ; Original ; Reoperation ; Treatment Outcome</subject><ispartof>Aging and disease, 2024-02, Vol.15 (1), p.408-420</ispartof><rights>Copyright: © 2024 Molina-Ramos et al. 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c344t-aa82dc40d2b8dbcd34784a3553efaa6bc8129ab423491f6774d623eeec0954d83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10796093/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10796093/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37307839$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Molina-Ramos, Ana Isabel</creatorcontrib><creatorcontrib>Ruiz-Salas, Amalio</creatorcontrib><creatorcontrib>Medina-Palomo, Carmen</creatorcontrib><creatorcontrib>Becerra-Muñoz, Víctor</creatorcontrib><creatorcontrib>Rodríguez-Capitán, Jorge</creatorcontrib><creatorcontrib>Romero-Cuevas, Miguel</creatorcontrib><creatorcontrib>Carmona-Segovia, Ada</creatorcontrib><creatorcontrib>Fernández-Lozano, Ignacio</creatorcontrib><creatorcontrib>Gómez-Doblas, Juan José</creatorcontrib><creatorcontrib>Jiménez-Navarro, Manuel</creatorcontrib><creatorcontrib>Pavón-Morón, Francisco Javier</creatorcontrib><creatorcontrib>Barrera-Cordero, Alberto</creatorcontrib><creatorcontrib>Alzueta-Rodríguez, Javier</creatorcontrib><title>Index and Repeat Ablation for Atrial Fibrillation in Older versus Younger Patients: A Propensity-Score Matching Analysis</title><title>Aging and disease</title><addtitle>Aging Dis</addtitle><description>Catheter ablation is a well-established rhythm control therapy in atrial fibrillation (AF). Although the prevalence of AF increases dramatically with age, the prognosis and safety profile of index and repeat ablation procedures remain unclear in the older population. The primary endpoint of this study was to assess the arrhythmia recurrence, reablation and complication rates in older patients. Secondary endpoints were the identification of independent predictors of arrhythmia recurrence and reablation, including information on pulmonary vein (PV) reconnection and other atrial foci. Older (n=129, ≥70 years) and younger (n=129, <70 years) patients were compared using a propensity-score matching analysis based on age, gender, obesity, hypertension, dyslipidemia, diabetes mellitus, dilated left atrium, severe obstructive sleep apnea, cardiac disease, left systolic ventricular function, AF pattern and ablation technique. Arrhythmia recurrence and reablation were evaluated in both groups using a Cox regression analysis in order to identify predictors. During a 30-month follow-up period, there were no significant differences between older and younger patients in the arrhythmia-free survival (65.1% and 59.7%; log-rank test p=0.403) and complication (10.1% and 10.9%; p>0.999) rates after the index ablation. However, the reablation rate was significantly different (46.7% and 69.2%; p<0.05, respectively). In those patients who underwent reablation procedure (redo subgroups), there were no differences in the incidence of PV reconnection (38.1% redo-older and 27.8% redo-younger patients; p=0.556). However, the redo-older patients had lower reconnected PVs per patient (p<0.01) and lower atrial foci (2.3 and 3.7; p<0.01) than the redo-younger patients. A further important finding was that age was not an independent predictor of arrhythmia recurrence or reablation. Our data reveal that the AF index ablation in older patients had a similar efficacy and safety profile to younger patients. Therefore, age alone must not be considered a prognostic factor for AF ablation but the presence of limiting factors such as frailty and multiple comorbidities.</description><subject>Aged</subject><subject>Atrial Fibrillation - epidemiology</subject><subject>Catheter Ablation - adverse effects</subject><subject>Heart Atria</subject><subject>Humans</subject><subject>Original</subject><subject>Reoperation</subject><subject>Treatment Outcome</subject><issn>2152-5250</issn><issn>2152-5250</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVUU1P3DAQtapWgChHrpWPvWRre-x8cKkiPgoSFajQQ0-WY08Wo6y9tRPE_nsCbBGdy3w9vXmaR8ghZwsuAcpv7clCMAELpjj_QPYEV6JQQrGP7-pdcpDzPZsDGgEN7JBdqIBVNTR75PEiOHykJjj6C9doRtp2gxl9DLSPibZj8magZ75LftjOfaBXg8NEHzDlKdM_cQrLub2e1xjGfERbep3iGkP246a4sTEh_WlGe-fDkrbBDJvs82fyqTdDxoNt3ie_z05vj8-Ly6sfF8ftZWFByrEwphbOSuZEV7vOOpBVLQ0oBdgbU3a25qIxnRQgG96XVSVdKQARLWuUdDXsk--vvOupW6Gzs8JkBr1OfmXSRkfj9f-b4O_0Mj5ozqqmZA3MDF-3DCn-nTCPeuWzxfkdAeOUtaiFUoyVwGdo8Qq1KeacsH-7w5l-cUy3J_rZMf3s2Iz_8l7cG_qfP_AEHSOSxA</recordid><startdate>20240201</startdate><enddate>20240201</enddate><creator>Molina-Ramos, Ana Isabel</creator><creator>Ruiz-Salas, Amalio</creator><creator>Medina-Palomo, Carmen</creator><creator>Becerra-Muñoz, Víctor</creator><creator>Rodríguez-Capitán, Jorge</creator><creator>Romero-Cuevas, Miguel</creator><creator>Carmona-Segovia, Ada</creator><creator>Fernández-Lozano, Ignacio</creator><creator>Gómez-Doblas, Juan José</creator><creator>Jiménez-Navarro, Manuel</creator><creator>Pavón-Morón, Francisco Javier</creator><creator>Barrera-Cordero, Alberto</creator><creator>Alzueta-Rodríguez, Javier</creator><general>JKL International LLC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20240201</creationdate><title>Index and Repeat Ablation for Atrial Fibrillation in Older versus Younger Patients: A Propensity-Score Matching Analysis</title><author>Molina-Ramos, Ana Isabel ; Ruiz-Salas, Amalio ; Medina-Palomo, Carmen ; Becerra-Muñoz, Víctor ; Rodríguez-Capitán, Jorge ; Romero-Cuevas, Miguel ; Carmona-Segovia, Ada ; Fernández-Lozano, Ignacio ; Gómez-Doblas, Juan José ; Jiménez-Navarro, Manuel ; Pavón-Morón, Francisco Javier ; Barrera-Cordero, Alberto ; Alzueta-Rodríguez, Javier</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c344t-aa82dc40d2b8dbcd34784a3553efaa6bc8129ab423491f6774d623eeec0954d83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Atrial Fibrillation - epidemiology</topic><topic>Catheter Ablation - adverse effects</topic><topic>Heart Atria</topic><topic>Humans</topic><topic>Original</topic><topic>Reoperation</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Molina-Ramos, Ana Isabel</creatorcontrib><creatorcontrib>Ruiz-Salas, Amalio</creatorcontrib><creatorcontrib>Medina-Palomo, Carmen</creatorcontrib><creatorcontrib>Becerra-Muñoz, Víctor</creatorcontrib><creatorcontrib>Rodríguez-Capitán, Jorge</creatorcontrib><creatorcontrib>Romero-Cuevas, Miguel</creatorcontrib><creatorcontrib>Carmona-Segovia, Ada</creatorcontrib><creatorcontrib>Fernández-Lozano, Ignacio</creatorcontrib><creatorcontrib>Gómez-Doblas, Juan José</creatorcontrib><creatorcontrib>Jiménez-Navarro, Manuel</creatorcontrib><creatorcontrib>Pavón-Morón, Francisco Javier</creatorcontrib><creatorcontrib>Barrera-Cordero, Alberto</creatorcontrib><creatorcontrib>Alzueta-Rodríguez, Javier</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Aging and disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Molina-Ramos, Ana Isabel</au><au>Ruiz-Salas, Amalio</au><au>Medina-Palomo, Carmen</au><au>Becerra-Muñoz, Víctor</au><au>Rodríguez-Capitán, Jorge</au><au>Romero-Cuevas, Miguel</au><au>Carmona-Segovia, Ada</au><au>Fernández-Lozano, Ignacio</au><au>Gómez-Doblas, Juan José</au><au>Jiménez-Navarro, Manuel</au><au>Pavón-Morón, Francisco Javier</au><au>Barrera-Cordero, Alberto</au><au>Alzueta-Rodríguez, Javier</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Index and Repeat Ablation for Atrial Fibrillation in Older versus Younger Patients: A Propensity-Score Matching Analysis</atitle><jtitle>Aging and disease</jtitle><addtitle>Aging Dis</addtitle><date>2024-02-01</date><risdate>2024</risdate><volume>15</volume><issue>1</issue><spage>408</spage><epage>420</epage><pages>408-420</pages><issn>2152-5250</issn><eissn>2152-5250</eissn><abstract>Catheter ablation is a well-established rhythm control therapy in atrial fibrillation (AF). Although the prevalence of AF increases dramatically with age, the prognosis and safety profile of index and repeat ablation procedures remain unclear in the older population. The primary endpoint of this study was to assess the arrhythmia recurrence, reablation and complication rates in older patients. Secondary endpoints were the identification of independent predictors of arrhythmia recurrence and reablation, including information on pulmonary vein (PV) reconnection and other atrial foci. Older (n=129, ≥70 years) and younger (n=129, <70 years) patients were compared using a propensity-score matching analysis based on age, gender, obesity, hypertension, dyslipidemia, diabetes mellitus, dilated left atrium, severe obstructive sleep apnea, cardiac disease, left systolic ventricular function, AF pattern and ablation technique. Arrhythmia recurrence and reablation were evaluated in both groups using a Cox regression analysis in order to identify predictors. During a 30-month follow-up period, there were no significant differences between older and younger patients in the arrhythmia-free survival (65.1% and 59.7%; log-rank test p=0.403) and complication (10.1% and 10.9%; p>0.999) rates after the index ablation. However, the reablation rate was significantly different (46.7% and 69.2%; p<0.05, respectively). In those patients who underwent reablation procedure (redo subgroups), there were no differences in the incidence of PV reconnection (38.1% redo-older and 27.8% redo-younger patients; p=0.556). However, the redo-older patients had lower reconnected PVs per patient (p<0.01) and lower atrial foci (2.3 and 3.7; p<0.01) than the redo-younger patients. A further important finding was that age was not an independent predictor of arrhythmia recurrence or reablation. Our data reveal that the AF index ablation in older patients had a similar efficacy and safety profile to younger patients. Therefore, age alone must not be considered a prognostic factor for AF ablation but the presence of limiting factors such as frailty and multiple comorbidities.</abstract><cop>United States</cop><pub>JKL International LLC</pub><pmid>37307839</pmid><doi>10.14336/AD.2023.0511</doi><tpages>13</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | Aging and disease, 2024-02, Vol.15 (1), p.408-420 |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| subjects | Aged Atrial Fibrillation - epidemiology Catheter Ablation - adverse effects Heart Atria Humans Original Reoperation Treatment Outcome |
| title | Index and Repeat Ablation for Atrial Fibrillation in Older versus Younger Patients: A Propensity-Score Matching Analysis |
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