Catheter ablation of atrial fibrillation in elderly population

Background Although elderly patients have been included in published series of catheter ablation for atrial fibrillation （AF）, clinicalbenefit and safety remain still less defined in this population. A retrospective analysis of the results of catheter ablation for AF in a large volumecenter focused on comparison of elderly patients with the rest of the patient cohort was conducted in this study. Methods Consecutive patientswho underwent catheter ablation for AF between January 2001 and December 2016 were analysed. A total population of 3197 patients wasdichotomized by the age of 70 years （394 elderly vs. 2803 younger subjects）. Patients were followed in terms of arrhythmia status and sur-vival for a median period of 18 vs. 21 and 35 vs. 57 months, respectively. Results Elderly patients were more frequently females （49% vs.29%, P 〈 0.0001）, had a history of hypertension （79% vs. 57%, P 〈 0.0001）, diabetes （16% vs. 11%, P 〈 0.01）, stroke （9% vs. 6%, P 〈 0.01）,coronary/peripheral artery disease （14% vs. 8%, P 〈 0.0001）, and CHAzDS2-VASc score （3.1 ± 1.3 vs. 1.5 ± 1.2 s, P 〈 0.0001）. Major com-plications were more frequent in elderly （5.3% vs. 3.2%, P = 0.03）; however, this difference was driven by vascular complications （3.6% vs.1.9%, P = 0.04）. There were comparable rates of cerebrovascular （0.3 vs. 0.3%） or nonvascular complications （1.8 vs. 1.2%）. Good arrhyth-mia control was inferior in elderly patients as compared with the rest of the cohort, both without and with antiarrhythmic drugs： 44.2% vs.58.2% （P 〈 0.0001） and 78.2 vs. 83.2% （P 〈 0.01）, respectively. Poor arrhythmia control was associated with relative risk of all-cause mor-tality of 2.7 （95% CI： 1.1-6.4） in elderly patients and 1.4 （95% CI： 0.9-2.0） in younger subjects. Conclusions Catheter ablation for AF inelderly patients is safe although somewhat less effective. Good arrhythmia control is associated with better survival, especially in elderly patients.

Atrial fibrillation in the elderly

Atrial fibrillation(AF)is the most common arrhythmia in elderly population,with age being one of the most important factors involved in its pathogenesis.Conduction disturbances may be present on the surface electrocardiogram before AF onset in some patients.Once this arrhythmia is diagnosed,antithrombotic therapy is mandatory in most cases,as this is the only treatment that has demonstrated to improve survival.Age increases both the risk of thromboembolic and bleeding complications,while benefits from anticoagulant therapy outweigh that from bleeding in most scenarios,also in very elderly patients.However,elderly patients with AF are often undertreated.Non-vitamin K antagonist oral anticoagulants have emerged as an alternative to vitamin K antagonists,with significant less adverse events and better profile in terms of efficacy and safety.Other conditions related to age should be carefully evaluated in these patients(including frailty,comorbidity and polypharmacy)to ensure an individualized clinical and therapeutic approach.

Catheter ablation for atrial fibrillation is associated with reduced risk of mortality in the elderly:a prospective cohort study and propensity score analysis

Background It is unclear whether catheter ablation(CA)for atrial fibrillation(AF)affects the long-term prognosis in the elderly.This study aims to evaluate the relationship between CA and long-term outcomes in elderly patients with AF.Methods Patients more than 75 years old with non-valvular AF were prospectively enrolled between August 2011 and December 2017 in the Chinese Atrial Fibrillation Registry Study.Participants who underwent CA at baseline were propensity score matched(1:1)with those who did not receive CA.The outcome events included all-cause mortality,cardiovascular mortality,stroke/transient ischemic attack(TIA),and cardiovascular hospitalization.Results Overall,this cohort included 571 ablated patients and 571 non-ablated patients with similar characteristics on 18 dimensions.During a mean follow-up of 39.75±19.98 months(minimum six months),24 patients died in the ablation group,compared with 60 deaths in the non-ablation group[hazard ratio(HR)=0.49,95%confidence interval(CI):0.30-0.79,P=0.0024].Besides,6 ablated and 29 non-ablated subjects died of cardiovascular disease(HR=0.25,95%CI:0.11-0.61,P=0.0022).A total of 27 ablated and 40 non-ablated patients suffered stroke/TIA(HR=0.79,95%CI:0.48-1.28,P=0.3431).In addition,140 ablated and 194 non-ablated participants suffered cardiovascular hospitalization(HR=0.84,95%CI:0.67-1.04,P=0.1084).Subgroup analyses according to gender,type of AF,time since onset of AF,and anticoagulants exposure in initiation did not show significant heterogeneity.Conclusions In elderly patients with AF,CA may be associated with a lower incidence of all-cause and cardiovascular mortality.

Is dual therapy the correct strategy in frail elderly patients with atrial fibrillation and acute coronary syndrome?

Atrial fibrillation(AF)is a very common arrhythmia in clinical practice.Its incidence and prevalence are age-related and are growing in the last years.Age is a risk factor also for coronary artery disease(CAD),and with the evolution of preventive care,the first event(acute coronary syndrome(ACS)or percutaneous coronary intervention(PCI))takes place at a later age.If elderly patients with AF and CAD undergo ACS or PCI,they have indication to assume triple therapy.Triple therapy(oral anticoagulation(OAC)plus dual antiplatelet therapy(DAPT))exposes patients to high bleeding risk.In the last 10 years,several clinical trials have tested dual therapy(OAC plus single antiplatelet therapy)in AF patients who undergo ACS or elective PCI.WOEST trial has tested warfarin+clopidogrel against triple therapy.PIONEER AF-PCI trial has tested low-dose rivaroxaban+P2Y12 inhibitor or very low-dose rivaroxaban+DAPT against standard triple therapy with warfarin.RE-DUAL PCI trial has tested two doses of dabigatran+P2Y12 inhibitor against standard triple therapy with Warfarin.AUGUSTUS trial has tested apixaban against warfarin both in dual therapy with P2Y12 inhibitor and in triple therapy with a P2Y12 inhibitor and aspirin.ENTRUST-AF PCI,last published study,has tested edoxaban+P2Y12 inhibitor against triple therapy.All these trials show dual therapy reduces significantly bleeding risk than triple therapy.In this paper,we analyze these clinical trials to understand if dual therapy results can be applied to elderly patients and what is probably the better approach in elderly AF patients undergo to ACS or PCI.

Atrial fibrillation in the elderly

Atrial fibrillation (AF) is an extremely common condition in the elderly, with increasing prevalence around the world as the population ages. AF may be associated with serious health consequences, including stroke, heart failure, and decreased quality of life, so that careful management of AF by geriatric health care providers is required. With careful attention to anticoagulation therapy, and prudent use of medications and invasive procedures to minimize symptoms, many of the adverse health consequences of AF can be prevented.

Atrial fibrillation in the elderly: Is ablation ready for prime time ?

Atrial fibrillation is the most common sustained arrhythmia and results in significant morbidity, especially in the elderly. The prevalence of atrial fibrillation increases dramatically with advancing age to almost 6% in individuals older than 65 years. In fact, 84% of people with atrial fibrillation are over 65 years of age.1 Additionally, the risk of stroke increases with advancing age, such that one-third of strokes in patients over the age of 65 are caused by atrial fibrillation.

Analysis of the Impact Factors on a Stable Warfarin Dose in Extreme Elderly (Age ≥ 80 Years) Chinese Patients with Non-Valvular Atrial Fibrillation

Purpose: The aim of this study was to investigate non-genetic and genetic factors contributing to stable warfarin dose change in the extreme elderly patients with non-valvular atrial fibrillation. Methods: A total of 40 elderly patients with stable warfarin doses were included in this study. Clinical basic data, such as age, sex, body mass index, basic disease like hypertension, diabetes and coronary heart disease had been recorded. Two nucleotide polymorphisms about VKORC1-1639G^A and CYP2C9 1075A^C genes were detected via sequencing by hybridization. Results: The elderly patients with CYP2C9 1075A^C (CA) genotype needed less warfarin daily doses than those?with CYP2C9 1075A^C (AA) genotype (1.93 ± 0.79 mg/d VS 2.15 ± 0.64 mg/d), but there was no significant difference (p = 0.601). While the daily warfarin dose required for patients with VKORC1-1639G^A (AA) genotype was significantly lower than that for patients with VKORC1-1639G^A (GA) genotype (2.00 ± 0.67 mg/d VS 2.63 ± 0.38 mg/d, p = 0.012). VKORC1-1639G^A together with age and diabetes status accounted 41.7% for dose variability. The new algorithm was developed using multivariate linear regression analysis;the model was developed for: Dose = 7.731 – 0.056 * age + 0.527 * DM - 0.785 * VKORC1. Conclusions: VKORC1-1639G^A together with age and diabetes status might predict warfarin doses in age ≥ 80 years patients with non-valvularatrial fibrillation. In contrast, the polymorphism of CYP2C9 1075A^C was not associated with dose variability.

Clinical Characteristics and Risk Factors of Atrial Fibrillation in the Elderly

Objective: To investigate the epidemiobgical characteristics of the elderly with atrial fibrillation (AF) in age, gender, the types of AF and relative causes. And To analyze the risk factors of persistent AF (PeAF), then use them to guide to prevent and treat for AF in the elderly.Methods: Collect the data of elderly patients with AF who were admitted to Liaoning People's Hospital from September 1, 2016 to September 30, 2017, and summarize the epidemiological characteristics of AF in the elderly. The risk factors for PeAF were analyzed by Spearman correlation analysis and mltivariate logistic regression analysis. Result: 1. In the elderly, the number of AF cases increase with age. The group of 75-84 years old was the largest part. The number of older females was larger than male in all ages. It was important to pay more attention to old woman with AF. 2.In the elderly, nonvalvular atrial fibrillation is popular. The top three causes of AF in the elderly were CHD, hypertension and heart failure. In the elderly, comorbidities were frequent, and the management was a major therapeutic objective. 3.CRP, 1eft atria diameter were the independent risk factors for PeAF in the elderly.

Clinical outcomes of radiofrequency catheter ablation of atrial fibrillation in octogenarians lO-year experience of a one high-volume center

Background Prevalence of atrial fibrillation （AF） increases with age. Radiofrequency catheter ablation （RFCA） is an establishedtreatment option superior to antiarrhythmics （AAs）. In this study, we investigated safety and efficacy of RFCA of AF in octogenarians.Methods From our database, we extracted procedural and follow-up data for patients 〉 80 years with symptomatic AF undergoing RFCAand compared this population to RFCA patients 〈 50 years. All patients underwent pulmonary vein isolation （PVI） supplemented by linearlesions in PVI-nonresponders. Arrhythmia-free survival was assessed using seven day Holter every three months post procedure. All patientscompleted their 12 months follow-up. Results Fifty patients aged ≥80 years （80.5 ± 1.6 years） were compared to 259 patients aged 〈 50years （43.5±5.5 years）. The RFCA complication rate did not vary between groups. No differences in procedural characteristics were seenafter being analyzed by type of AF. Among patients with paroxysmal AF, 71.4% octogenarian vs. 84.7% young patients was free of anyarrhythmia, without AAs, after single procedure. For non-paroxysmal AF, arrhythmia-free survival without AAs, was considerably lower（58.6% octogenarians vs. 81.2% younger patients, P = 0.023）. If AAs were used, arrhythmia-free survival for paroxysmal AF increased to90.5% and 92.1% in octogenarians and younger patients, respectively; and in non-paroxysmal AF it increased to 79.3% vs. 88.4%. ConclusionsRFCA is a safe and effective strategy to achieve normal sinus rhythm in a highly selected group of octogenarians. Paroxysmal AF ablation inoctogenarians has similar clinical effectiveness as that seen in much younger patients. Non-paroxysmal AF ablation has lower, but still rea-sonable clinical effectiveness.

Analyses of risk factors and prognosis for new-onset atrial fibrillation in elderly patients after dual-chamber pacemaker implantation

Objective To retrospectively identify risk factors and the prognosis for new-onset atrial fibrillation (AF)after implantation of dual-chamber pacemakers in elderly patients.Methods Consecutive patients aged >65years who underwent their first implantation of a dual-chamber permanent pacemaker in Beijing Anzhen Hospital from October 2013to May 2016were enrolled.Their complete program- ming and follow-up data were recorded.Follow-up end points included new-onset AF and major adverse cardiovascular and cerebrovascular events.Restdts Altogether,322patients were enrolled,with new-onset AF observed in 79(24.5%)during their follow-up.Multivariable analysis identified four independent predictors of new-onset AF in elderly patients after pacemaker implantation:hypertension (HR =3.040, 95%CI:1.09-3.05,P =0.00),age (HR =1.966,95%CI:1.57-3.68,P =0.01);left atrial enlargement (HR =1.645,95%CI:1.05-1.25,P = 0.03);high ventricular pacing rate (HR =1.137,95%CI:1.01-1.06,P =0.01).Univariable analysis indicated that the CHA2DS2-VASc score was also a risk factor for AF (HR =1.368,95%CI:1.178-1.589,P =0.002),whereas multivariable regression analysis did not. Kaplan-Meier survival analysis showed that the risk for ischemic stroke was significantly higher in the new-onset AF group than in the non-AF group (P <0.05).Conclusion Hypertension,age,left atrial enlargement,and high ventricular pacing rate were independent predictors of new-onset AF in elderly patients after implantation of a permanent pacemaker.New-onset AF increased the risk for ischemic stroke.

Percutaneous interventions in elderly patients with atrial fibrillation： leftatrial ablation and left atrial appendage occlusion

Heart rhythm disturbances become of special importancewhen patients reach a senior age. Atrial fibrillation （AF） isthe most prevalent arrhythmia among the old age groups,and its impact on morbidity and mortality becomes of para-mount significance. In this population, AF is responsible forsignificant amount of thromboembolic cerebrovascularevents, especially for disabling and fatal strokes, Follow-ing announcement of the special issue of the Journal of Geri-atric Cardiology devoted to heart rhythm disorders in theelderly, a number of submissions have been received withAF as the major topic of authors＇ researches.

Hyperuricemia predicted adverse outcomes in very elderly patients with non-valvular atrial fibrillation

Objective Elevated serum uric acid predicts poor outcomes in patients with cardiovascular disease.We aimed to examine associations between hyperuricemia and clinical outcomes among very elderly patients with non-valvular atrial fibrillation(NVAF).Methods Elderly patients(≥80 years)with NVAF admitted to our hospital from January 2009 to December 2015 were retrospectively studied and were followed up until April 2017.

Pulse Pressure as a Risk Factor of Atrial Fibrillation in Black African Elderly Patients

Objective: The aim of this study was to show the prognostic role of High Pulse Pressure (PP) in the occurrence of atrial fibrillation in Black African elderly patients. Materials and Methods: In a comparative retrospective study related to 2000 patients admitted to the Institute of Cardiology of Abidjan, from January 1991 to December 2010 for atrial fibrillation, we matched pulse pressure and atrial fibrillation in Black African elderly patients. Results: The mean age of patients was 65 ± 10 years. Patients with high pulse pressure were 4.8 times more at risk to present atrial fibrillation than those with normal pulse pressure. The threshold of high risk pulse pressure was 65 mmHg. Conclusion: Pulse pressure is a factor of bad prognosis of atrial fibrillation in Black African elderly patients.

Opportunistic screening for atrial fibrillation with a single lead device in geriatric patients

Objective To determine the diagnostic yield of repeated screening for atrial fibrillation(AF)among geriatric patients.Methods A pragmatic prospective cohort study into applying opportunistic screening for AF with a handheld single lead ECG device(SLD)in a geriatric cohort.Consecutive patients of 65 years old and older visiting the geriatric outpatient clinic were eligible for inclusion.A 12 lead ECG was performed,followed by measurements with the SLD during every visit to the geriatric outpatient clinic.A frailty index was based on the accumulation of deficits model.Results 478 patients were eligible.Patients were excluded if they did not give informed consent(17 patients),had a pacemaker or implantable cardioverter defibrillator(20 patients),or had incomplete medical files(two patients).After exclusion,439 patients participated in this study.The mean age was 78 years(range 65 to 100 years),54%were female.AF was known in 89 patients(20%),first detected on the baseline ECG in four patients(1%)and first detected with the SLD in 20 patients(5%)during follow up visits.Sensitivity of the SLD was 90.0%,specificity 99.0%,negative predictive value 99.7%,and positive predictive value 73.5%.Most patients(82%)with AF were frail and 53%were severely frail.Conclusion Repeated screening in geriatric patients has a five times higher diagnostic yield than usual care.It was easily combined with usual care.Because of the positive predictive value of 73.5%,it remains necessary to confirm AF with a 12 lead ECG or 24-h Holter monitoring.

Insight into appropriate medication prescribing for elderly in the COVID-19 era

Coronavirus disease 2019(COVID-19)complicates clinical management in elderly population.There is an additional need to properly treat and monitor elderly COVID-19 patients.This paper discusses the inappropriate medication prescribing in the elderly and suggests an updated valid assessment tool considering COVID-19 and its treatment.

Comparison of long-term outcome between patients aged 〈 65 years vs. ≥ 65 years after atrial fibrillation ablation

Background Atrial fibrillation （AF） is the most frequent arrhythmia, and its prevalence is increasing with aging. We aimed to com-pare the long-term outcome data of patients 〈 65 years vs.≥ 65 years who underwent catheter ablation （CA） for drug-refractory AF. MethodsConsecutive patients with primary pulmonary vein isolation performed between March 2001 and December 2011, and those who completeda five-year of follow-up were divided into two groups： patients aged 〈 65 years into group 1, and patients aged ≥ 65 into group 2. Long-termoutcome data concerning mortality, thromboembolic events （TE） and success rates were compared between these groups. Results A totalnumber of 390 patients were included, group 1 contained 310 patients, and 80 patients in group 2. In group 2, patients had more often impairedrenal function （P 〈 0.001） and thyroid disease （P = 0.047）. A total of fifteen patients died during the 6.63 ± 2.1 years of follow-up, with a sig-nificantly higher incidence in the older group （8/80 vs. 7/310 patients, P = 0.004）. The majority of fatal outcome was due to cancerous dis-eases in both groups. No difference was observed concerning the long-term TE rate （12/310 vs. 4/80 patients, P = 0.75）. Rhythm controlfailed in 25.9% of the patients, with no difference between the groups： 26.4% in group 1 vs. 23.7% in group 2 （P = 0,67）, ConclusionsDespite growing prevalence of AF in aging population, the elderly patients are underrepresented in CA procedures. Similar clinical successand TE complication rate are observed between the age-groups. Our data suggest more liberal criteria might be applied while selecting pa-tients for AF ablation.

Prevalence and Risk Factors of Atrial Fibrillation in Chinese Elderly： Results from the Chinese Longitudinal Healthy Longevity Survey

Background： Prevalence of atrial fibrillation （AF） is increasing as the world ages. AF is associated with higher risk of mortality and disease, including stroke, hypertension, heart failure, and dementia. Prevalence of AF differs with each population studied, and research on non-Western populations and the oldest old is scarce. Methods： We used data from the 2012 wave of the Chinese Longitudinal Healthy Longevity Survey, a community-based study in eight longevity areas in China, to estimate AF prevalence in an elderly Chinese population （n = 1418, mean age = 85.6 years） and to identify risk factors. We determined the presence olAF in our participants using single-lead electrocardiograms. The weighted prevalence olAF was estimated in subjects stratified according to age groups （65-74, 75 84, 85-94, 95 years and above） and gender. We used logistic regressions to determine the potential risk factors of AF. Results： The overall prevalence of AF was 3.5%; 2.4% of men and 4.5% of women had AF （P 〈 0.05）. AF was associated with weight extremes of being underweight or overweight/obese. Finally, advanced age （85 94 years）, history of stroke or heart disease, low high-density lipoprotein levels, low triglyceride levels, and lack of regular physical activity were associated with AF. Conclusions： In urban elderly AF prevalence increased with age （P 〈 0.05）, and in rural elderly, women had higher AF prevalence （P 〈 0.05）. Further exploration of population-specific risk factors is needed to address the AF epidemic.

永久起搏器植入术后患者房颤发生现状及高危因素调查研究

目的:探讨永久起搏器植入术后患者房颤(AF)高危因素。方法:回顾性分析永久起搏器植入术后患者的临床资料,分析永久起搏器植入术后患者AF发生的危险因素。结果:年龄大、LADs大、心房起搏-心室起搏是永久起搏器植入术后患者AF发生的独立危险因素(P<0.05)。曲线分析显示,当logit(P)>12.97时,曲线下面积(AUC)值为0.910,95%CI为0.873~0.940,χ^(2)为19.101,诊断敏感度为84.85%,特异度为87.30%。结论:永久起搏器植入术后AF发生风险较高,其独立危险因素包括年龄大、LADs大、心房起搏-心室起搏。

CHA2DS2-VASc评分联合LVEF预测慢性心力衰竭合并永久性心房颤动患者发生认知功能障碍的价值

目的探讨心房颤动血栓发生危险度(CHA2DS2-VASc)评分联合左心室射血分数(LVEF)预测慢性心力衰竭合并永久性心房颤动患者发生认知功能障碍的价值。方法回顾性分析2019年12月至2021年12月郑州市中心医院收治的299例慢性心力衰竭合并永久性心房颤动患者的资料,根据是否发生认知功能障碍分为认知功能障碍组和认知功能正常组。分析CHA2DS2-VASc评分联合LVEF预测慢性心力衰竭合并永久性心房颤动患者发生认知功能障碍的价值。结果认知功能障碍组患者性别、受教育程度、吸烟史、糖尿病、脑卒中、NYHA分级构成比与认知功能正常组患者比较,差异均有统计学意义(P<0.05),认知功能障碍组患者年龄、CHA2DS2-VASc评分、N端脑钠肽前体(NTproBNP)均高于认知功能正常组患者(P<0.05),认知功能障碍组患者收缩压、LVEF均低于认知功能正常组患者(P<0.05);年龄、受教育程度、LVEF、NTproBNP、CHA2DS2-VASc评分均是影响慢性心力衰竭合并永久性心房颤动患者发生认知功能障碍的独立危险因素(P<0.05);慢性心力衰竭合并永久性心房颤动患者CHA2DS2-VASc评分与LVEF呈负相关(r=-0.417,P=0.000);CHA2DS2-VASc评分,LVEF预测慢性心力衰竭合并永久性心房颤动患者发生认知功能障碍的最佳截断值分别为4分和43%,二者联合的敏感度、特异度和AUC分别为82.43%,96.03%和0.930。结论LVEF和CHA2DS2-VASc评分均是影响慢性心力衰竭合并永久性心房颤动患者发生认知功能障碍的独立危险因素,二者均可作为预测患者发生认知功能障碍的参考指标,且联合预测的价值更高。

高龄心房颤动伴功能性三尖瓣反流的危险因素分析

目的:分析高龄心房颤动伴功能性三尖瓣反流的危险因素。方法:选取242例高龄心房颤动伴三尖瓣反流患者作为研究对象,跟踪随访1年,分析入组和随访1年后相关指标的差异性。采用Logistic回归分析、ROC曲线分析高龄心房颤动伴三尖瓣反流的影响因素及预测因子。结果:与入组时相比,随访1年后数据显示三尖瓣反流量明显增加,平均值为(7.1±0.5)m L,范围波动在0~40mL,且肌酐、尿酸、同型半胱氨酸(homocysteine,HCY)、三尖瓣反流、左心房左右径、左心房前后径、左心房上下径、右心房左右径、右心房上下径、LVEDD、LVESD、右心室内径及永久心脏起搏器置入术,差异有统计学意义(P<0.05)。三尖瓣反流组和非反流组在肌酐、尿素氮、胱抑素C、HCY、NT-proBNP、左心房左右径、左心房前后径、左心房上下径、右心房左右径、右心房上下径、右心室内径、LVEF、冠心病、高血压、慢性心力衰竭、慢性肾功能不全、永久心脏起搏器置入术,两组间差异有统计学意义(P<0.05)。其中,高龄心房颤动伴三尖瓣反流可能受右心房左右径(P=0.028)、永久心脏起搏器置入术(P=0.001)等因素影响;ROC曲线分析发现,右心房左右径(曲线下面积=0.753)、永久心脏起搏器置入术(曲线下面积=0.682)是高龄心房颤动患者发生三尖瓣反流的危险因素。结论:右心房左右径、永久心脏起搏器置入术不仅与高龄心房颤动伴三尖瓣反流存在关联性,也可作为高龄心房颤动伴功能性三尖瓣反流的预测因子。