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Acute safety outcomes in younger and older patients with atrial fibrillation treated with catheter ablation

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Catheter ablation for atrial fibrillation (AF) has been demonstrated to be safe and effective in subsets of patients with AF, but primarily in patients age <65. This study compared acute safety in patients age ≥65 vs. those <65 who have undergone catheter ablation for AF.

Methods

A retrospective analysis of data from two Thomson Reuters MarketScan® research databases was performed on 5,947 patients who underwent catheter ablation for treatment of AF. Acute safety was measured as a composite endpoint of procedure-related adverse events coded ≤7 days post-procedure. A logistic regression model was fitted to this endpoint, using age (<65, ≥65) and relevant covariates. Peri-procedural mortality rates were examined among patients with inpatient ablation procedures, where death rates could be determined by discharge status.

Results

The acute safety event rate was nearly identical between both groups. This finding persisted after adjusting for covariates in the logistic regression model (p = 0.6648). There were no peri-procedural mortalities among the 3,575 index ablation procedures performed in an inpatient setting.

Conclusion

Acute safety of catheter ablation for AF in patients ≥65 was consistent with that of younger patients. A prior history of hypertension and stroke was associated with a high risk for complications with AF ablation. These findings in a large, real world population may have implications for Medicare patients with AF.

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Abbreviations

AF:

Atrial fibrillation

TIA:

Transient ischemic attack

AV:

Atrioventricular

ICD:

Implantable cardioverter defibrillator

MI:

Myocardial infarction

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Financial support

Steven Hao, MD, FACC, FHRS is a consultant for Biosense Webster, Inc., and Medtronic. Tina Hunter, PhD and Candace Gunnarsson, EdD are employees of S2 Statistical Solutions, Inc., which is a paid consultant to Biosense Webster, Inc. Jamie March, MBA, and Sarah White, MPH were employed by Biosense Webster, Inc., when the research was conducted. Joseph Ladapo, MD, PhD is a paid consultant for S2 Statistical Solutions, Inc. Matthew Reynolds, MD, MSc has received research grants on behalf of Biosense Webster, Inc., and Sanofi-Aventis and consulting/honoraria from Biosense Webster, Inc., Sanofi-Aventis, and St. Jude Medical. This study was funded by Biosense Webster, Inc., Diamond Bar, CA

Author information

Authors and Affiliations

  1. Cardiovascular Disease, Electrophysiology, Sutter Pacific Medical Foundation, 2100 Webster St. Suite 521, San Francisco, CA, 94115, USA

    Steven C. Hao

  2. S2 Statistical Solutions, Inc., 11176 Main Street, Cincinnati, OH, 45241, USA

    Tina D. Hunter & Candace Gunnarsson

  3. Global Health Economics, Outcomes Research and Policy, Biosense Webster, Inc., 3333 Diamond Canyon Road, Diamond Bar, CA, 91765, USA

    Jamie L. March & Sarah A. White

  4. Department of Medicine, New York University School of Medicine, 550 1st Ave. VZ30 6th Floor, Room 614, New York, NY, 10016, USA

    Joseph A. Ladapo

  5. Cardiology, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Boston, MA, 02215, USA

    Matthew R. Reynolds

  6. Cardiology, VA Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA, 02132, USA

    Matthew R. Reynolds

Authors
  1. Steven C. Hao
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  2. Tina D. Hunter
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  3. Candace Gunnarsson
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  4. Jamie L. March
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  5. Sarah A. White
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  6. Joseph A. Ladapo
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  7. Matthew R. Reynolds
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Corresponding author

Correspondence to Candace Gunnarsson.

Additional information

Editorial Commentary

This study compares acute outcomes of catheter ablation for atrial fibrillation (AF) among patients above age 65 to those under age 65 years using insurance claims data. The investigators found no difference in the overall complication rate among patients over age 65 years. Even though older patients had more comorbidities, adverse events were not more frequent in the elderly, with the exception of acute myocardial infarction which was more common in the older patients having ablation.

There is a lot of interest in the safety of catheter ablation for AF in the elderly. The strengths of this data are the "real world" nature of the data, the large numbers of patients, and the lower likelihood of underreporting of events compared to reports based on surveys. Limitations include the possible overestimation of the overall complication rate because outpatients who had complications were likely converted to inpatients (the group analyzed here), the strong possibility that the older patients who were selected for catheter ablation in this database were not representative of the average elderly patient. It is also limited by the coding structure of insurance claims and there is no validation of the coding.

Appendix A

Appendix A

Table 4 Safety endpoint codes
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Hao, S.C., Hunter, T.D., Gunnarsson, C. et al. Acute safety outcomes in younger and older patients with atrial fibrillation treated with catheter ablation. J Interv Card Electrophysiol 35, 173–182 (2012). https://doi.org/10.1007/s10840-012-9690-5

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  • DOI: https://doi.org/10.1007/s10840-012-9690-5

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