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Outcomes of AF Ablation Among Older Adults in the US
Quick Takes
- AF ablation procedure volume in the US has increased from 83.8 (2017) to 111.6 per 100,000 patient-years (2021). There was a significant decrease in complication rates and hospitalizations, with no significant change in mortality.
- The most common periprocedural complications of AF ablation were bleeding (1.8%), pericardial effusion (1.4%), and vascular access damage (0.8%).
Study Questions:
What are the patient characteristics, population rates, and 30-day outcomes of pulmonary vein isolation (PVI) in a nationwide sample of US adults aged >65 years?
Methods:
First-time PVIs were identified among US Medicare fee-for-service beneficiaries using Current Procedural Terminology procedural codes. Comorbidities were ascertained using International Classification of Diseases-10th Revision diagnosis codes associated with each procedural claim. Outcomes included periprocedural complications, all-cause hospitalizations, and mortality at 30 days.
Results:
From 2017 through 2021, a total of 227,133 patients underwent PVI (mean age 73 years, 42% female, 93% White) with an increasing comorbidity burden over time. PVI volume increased from 83.8 (2017) to 111.6 per 100,000 patient-years (2021), which was driven by outpatient procedures (88% of all PVIs). Concurrently, there was a significant decrease in complication rates (3.9% in 2017 vs. 3.1% in 2021) and hospitalizations (8.8% vs. 7.0%), with no significant change in mortality (0.4%). The most common periprocedural complications were bleeding (1.8%), pericardial effusion (1.4%), and vascular access damage (0.8%).
Conclusions:
The authors conclude that the use of PVI has steadily increased among older patients, yet complication and hospitalization rates at 30 days have decreased.
Perspective:
As studies have consistently shown greater efficacy and better quality of life with catheter ablation of AF over antiarrhythmic medication, the procedure is increasingly recommended as first-line treatment of AF. The current study provides some reassurance that even older patients have good outcomes and low complication rates. Over the span of 5 years in the study, the annual volume of PVI procedures has increased at almost 5% per year, and the overall rate of complications and hospitalizations has decreased. Mortality has remained low at 0.4%. These findings encourage future outcomes research on this increasingly common procedure.
Clinical Topics: Arrhythmias and Clinical EP, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Atrial Fibrillation, Ablation
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