Purpose: We prospectively compared the efficacy, safety, and quality of life (QoL) impact of catheter ablation versus antiarrhythmic drugs (AAD) in elderly patients with persistent atrial fibrillation (AF). Methods: Four hundred and twelve consecutive patients, aged ≥ 70 years, underwent ablation (Group A, 153 patients) or AAD (Group B, 259 patients). Study endpoints: treatment failure (any AF/AT lasting > 30 seconds) and treatment-related adverse events (acute when ≤ 1 month of procedure and long-term when > 1 month). The Medical Outcomes Study SF-36 Health Survey was used to assess QoL at baseline and at the end of follow-up for all patients. Results: At a follow-up of 60±17 months, 43% and 46% patients in Group B vs. 58% and 76% in Group A were in sinus rhythm (SR), respectively after one (p=0.003) and two procedures (p<0.001). Fifteen acute adverse events occurred (6.7% in Group A vs. 1% in Group B, p<0.001), mainly periprocedural cerebral thromboembolism (3.3% in Group A vs. 0.7% in Group B, p=0.058). Previous TIA/stroke resulted the only independent predictor of periprocedural cerebrovascular accidents (OR 1.2, 95%IC 1.1-1.3). At follow-up, 74 long-term adverse events occurred (7.7% in Group A vs. 23.9% in Group B, p<0.001) with Group B patients more often experiencing AAD-related adverse events (12.7% vs. 2.6%, p<0.001). Group A and absence of AF/AT recurrences significantly improved QoL scores (p<0.001). Conclusions: In elderly persistent AF patients, catheter ablation is more effective in maintaining SR and in improving QoL than AAD but is affected by a higher risk of embolic complications, particularly in patients with previous TIA/stroke. Over time, Group A patients more likely discontinued AAD with a reduction of long-term adverse events.

Long-term efficacy and safety of two different rhythm control strategies in elderly patients with symptomatic persistent atrial fibrillation

BLANDINO, ALESSANDRO;ANSELMINO, Matteo;BATTAGLIA, Alberto;GAITA, Fiorenzo
2013-01-01

Abstract

Purpose: We prospectively compared the efficacy, safety, and quality of life (QoL) impact of catheter ablation versus antiarrhythmic drugs (AAD) in elderly patients with persistent atrial fibrillation (AF). Methods: Four hundred and twelve consecutive patients, aged ≥ 70 years, underwent ablation (Group A, 153 patients) or AAD (Group B, 259 patients). Study endpoints: treatment failure (any AF/AT lasting > 30 seconds) and treatment-related adverse events (acute when ≤ 1 month of procedure and long-term when > 1 month). The Medical Outcomes Study SF-36 Health Survey was used to assess QoL at baseline and at the end of follow-up for all patients. Results: At a follow-up of 60±17 months, 43% and 46% patients in Group B vs. 58% and 76% in Group A were in sinus rhythm (SR), respectively after one (p=0.003) and two procedures (p<0.001). Fifteen acute adverse events occurred (6.7% in Group A vs. 1% in Group B, p<0.001), mainly periprocedural cerebral thromboembolism (3.3% in Group A vs. 0.7% in Group B, p=0.058). Previous TIA/stroke resulted the only independent predictor of periprocedural cerebrovascular accidents (OR 1.2, 95%IC 1.1-1.3). At follow-up, 74 long-term adverse events occurred (7.7% in Group A vs. 23.9% in Group B, p<0.001) with Group B patients more often experiencing AAD-related adverse events (12.7% vs. 2.6%, p<0.001). Group A and absence of AF/AT recurrences significantly improved QoL scores (p<0.001). Conclusions: In elderly persistent AF patients, catheter ablation is more effective in maintaining SR and in improving QoL than AAD but is affected by a higher risk of embolic complications, particularly in patients with previous TIA/stroke. Over time, Group A patients more likely discontinued AAD with a reduction of long-term adverse events.
2013
Ehra Europace
Athene
23/06/13-26/06/13
15
2
216
216
http://europace.oxfordjournals.org/content/europace/15/suppl_2/ii216.full.pdf
A. Blandino; E. Toso; M. Scaglione; M. Anselmino; F. Ferraris; D. Sardi; A. Battaglia; F. Gaita
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/158559
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