Anticoagulant therapy and risk of cerebrovascular events after catheter ablation of atrial fibrillation in the elderly

Aurelie Guiot, Krit Jongnarangsin, Aman Chugh, Arisara Suwanagool, Rakesh Latchamsetty, James D Myles, Qingmei Jiang, Thomas Crawford, Eric Good, Frank Pelosi, Frank Bogun, Fred Morady, Hakan Oral
Journal of Cardiovascular Electrophysiology 2012, 23 (1): 36-43

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 CHADS(2) 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 CHADS(2) score (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes mellitus and prior Stroke or transient ischemic attack).

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