Anticoagulant Therapy After Ablation of AF in the Elderly
Stroke and Atrial Fibrillation Ablation.. Introduction: Factors associated with cerebrovascular events (CVEs) after radiofrequency catheter ablation (RFA) of atrial fibrillation (AF) have not been well defined in elderly patients (≥65 years). The purpose of this study was to determine the prevalence and predictors of CVEs after RFA in patients with AF ≥65 years old, in comparison to patients <65 years, and with or without AF.
Methods and Results: This study included 508 consecutive patients ≥65 years old (mean age: 70 ± 4 years), who underwent RFA for paroxysmal (297) or persistent (211) AF. A stratified group of 508 patients < 65 years old who underwent RFA for AF served as a control group. All patients were anticoagulated with warfarin for ≥3 months after RFA. A perioperative CVE (≤4 weeks after RFA) occurred in 0.8% and 1% of patients ≥65 and <65 years old, respectively (P = 1). Among the patients ≥65 years old who remained in sinus rhythm after RFA, warfarin was discontinued in 60% and 56% of the patients with a CHADS2 score of 0 and ≥1, respectively. Paroxysmal AF, no history of CVE, and successful RFA were independent predictors of discontinuing warfarin. During a mean follow-up of 3 ± 2 years, a late CVE (>4 weeks after the RFA) occurred in 15 of 508 (3%) of patients ≥65 years old (1% per year) and in 5 of 508 (1%) patients <65 years old (0.3% per year, P = 0.03). Among patients ≥65 years old, age >75 years old (OR = 4.9, ±95% CI: 3.3–148.5, P = 0.001) was the only independent predictor of a CVE. Among patients <65 years old, body mass index was the only independent predictor of a late CVE (OR = 1.2, ±95% CI: 1.03–1.33, P = 0.02).
Conclusions: The risk of a periprocedural CVE after RFA of AF is similar among patients ≥65 and <65 years old. Late CVEs after RFA are more prevalent in older than younger patients with AF, and age >75 years old is the only independent predictor of late CVEs regardless of the rhythm, anticoagulation status, or the CHADS2 score (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes mellitus and prior Stroke or transient ischemic attack).
Atrial fibrillation (AF) is associated with a 5- to 6-fold increase in the risk of cerebrovascular events (CVE) and is the leading cause of ischemic strokes. Although maintenance of sinus rhythm would be expected to restore atrial contractile function and eliminate the propensity for endovascular thrombus formation because of stasis, it has been suggested that patients with AF have intrinsic thrombophilia independent of the rhythm and that AF is a surrogate comorbidity of a systemic disease.
Anticoagulation with warfarin can have a profound effect on quality of life and is associated with a risk of major bleeding. Therefore, discontinuation of systemic anticoagulation after successful radiofrequency catheter ablation (RFA) of AF bears substantial significance. A prior study suggested that anticoagulation safely can be discontinued after RFA in patients ≤65 years old. However, it is not clear whether systemic anticoagulation also can be safely discontinued in older patients, who are at higher risk for CVEs. The purpose of this study was to determine the prevalence and predictors of CVEs after RFA of AF in patients ≥65 years old in comparison to patients <65 years old.
Abstract and Introduction
Abstract
Stroke and Atrial Fibrillation Ablation.. Introduction: Factors associated with cerebrovascular events (CVEs) after radiofrequency catheter ablation (RFA) of atrial fibrillation (AF) have not been well defined in elderly patients (≥65 years). The purpose of this study was to determine the prevalence and predictors of CVEs after RFA in patients with AF ≥65 years old, in comparison to patients <65 years, and with or without AF.
Methods and Results: This study included 508 consecutive patients ≥65 years old (mean age: 70 ± 4 years), who underwent RFA for paroxysmal (297) or persistent (211) AF. A stratified group of 508 patients < 65 years old who underwent RFA for AF served as a control group. All patients were anticoagulated with warfarin for ≥3 months after RFA. A perioperative CVE (≤4 weeks after RFA) occurred in 0.8% and 1% of patients ≥65 and <65 years old, respectively (P = 1). Among the patients ≥65 years old who remained in sinus rhythm after RFA, warfarin was discontinued in 60% and 56% of the patients with a CHADS2 score of 0 and ≥1, respectively. Paroxysmal AF, no history of CVE, and successful RFA were independent predictors of discontinuing warfarin. During a mean follow-up of 3 ± 2 years, a late CVE (>4 weeks after the RFA) occurred in 15 of 508 (3%) of patients ≥65 years old (1% per year) and in 5 of 508 (1%) patients <65 years old (0.3% per year, P = 0.03). Among patients ≥65 years old, age >75 years old (OR = 4.9, ±95% CI: 3.3–148.5, P = 0.001) was the only independent predictor of a CVE. Among patients <65 years old, body mass index was the only independent predictor of a late CVE (OR = 1.2, ±95% CI: 1.03–1.33, P = 0.02).
Conclusions: The risk of a periprocedural CVE after RFA of AF is similar among patients ≥65 and <65 years old. Late CVEs after RFA are more prevalent in older than younger patients with AF, and age >75 years old is the only independent predictor of late CVEs regardless of the rhythm, anticoagulation status, or the CHADS2 score (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes mellitus and prior Stroke or transient ischemic attack).
Introduction
Atrial fibrillation (AF) is associated with a 5- to 6-fold increase in the risk of cerebrovascular events (CVE) and is the leading cause of ischemic strokes. Although maintenance of sinus rhythm would be expected to restore atrial contractile function and eliminate the propensity for endovascular thrombus formation because of stasis, it has been suggested that patients with AF have intrinsic thrombophilia independent of the rhythm and that AF is a surrogate comorbidity of a systemic disease.
Anticoagulation with warfarin can have a profound effect on quality of life and is associated with a risk of major bleeding. Therefore, discontinuation of systemic anticoagulation after successful radiofrequency catheter ablation (RFA) of AF bears substantial significance. A prior study suggested that anticoagulation safely can be discontinued after RFA in patients ≤65 years old. However, it is not clear whether systemic anticoagulation also can be safely discontinued in older patients, who are at higher risk for CVEs. The purpose of this study was to determine the prevalence and predictors of CVEs after RFA of AF in patients ≥65 years old in comparison to patients <65 years old.
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