Outcomes of Medicare Beneficiaries Undergoing Catheter Ablation for Atrial Fibrillation

Study Questions:

How safe is catheter ablation (CA) of atrial fibrillation (AF) in patients 65 years or older?

Methods:

This was a retrospective analysis of the US Centers for Medicare and Medicaid Services database. All patients 65 years or older who underwent CA of AF in 2007-2009 were included. The sample size was 15,423 patients, with a mean age of 72 years. Outcomes were tracked for 1 year post-CA.

Results:

The mortality rate at 30 days was 0.8%. The 30-day rates of myocardial infarction, pericardial effusion, stroke, and vascular complications requiring surgery were 0.3%, 1.7%, 0.8%, and 0.5%, respectively. The mortality rate at 1 year was 3.8%. The 1-year rates of heart failure, stroke, hospitalization, and repeat CA were 2.5%, 2.1%, 43%, and 11%. Renal impairment (hazard ratio [HR], 2.1), age >80 years (HR, 3.1), and heart failure (HR, 2.5) were independent risk factors for death at 1 year. The mortality rate was 5 times higher in patients older than 80 years than in patients 69 years or younger. Older age independently was predictive of all major complications.

Conclusions:

The overall risk of death and major complications after CA of AF is relatively low in Medicare beneficiaries, but the risk increases with advanced age.

Perspective:

The redo CA rate of only 11% almost certainly is considerably lower than the AF recurrence rate. Although the complication rates in this study were relatively low, it is difficult to place the results in proper perspective in the absence of accurate information on efficacy, and in the absence of control groups of patients under the age of 65 years who underwent CA, and older patients with AF who did not undergo CA.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: Stroke, Heart Failure, Centers for Medicare and Medicaid Services (U.S.), Atrial Fibrillation, Medicare, Catheter Ablation


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