ESC Journals
Prompt treatment of atrial fibrillation is essential to reduce mortality and morbidity and increase quality of life. Catheter ablation remains one of effective treatments, yet its efficacy on elderly was unknown. In addition, elderly have different drug tolerance, thus results on the general population were not reliable.
Compare the outcomes of catheter ablation (CA) versus antiarrhythmic drug (ARD) for older patients (55 and above) with AF.
The protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021262067).
Nine studies involving 2,307 patients were included. The majority of studies had low risk-of-bias. CA was associated with lower mortality (OR = 0.40; 95% CI [0.27,0.61]; p < 0.0001), recurrence rate (OR = 0.31; 95% CI [0.15,0.65]; p = 0.002) and higher quality of life measured with SF-36 (MD = 4.78; 95% CI [2.28,7.28]; p = 0.0002) compared to those who received ARD only. Improvement in left ventricular ejection fraction (MD = 4.53; 95% CI [2.18,6.87]; p = 0.0002) and brain natriuretic peptide level (MD=-108.85; 95% CI [-195.59,-22.11]; p = 0.01) were also observed. There were some risks of cerebrovascular accidents post-ablation (OR = 0.46; 95% CI [0.25,0.85]; p = 0.01).
CA seems to offer more clinical benefits than ARD among older patients, however its execution must be warranted by patient-tailored therapy choice.