Comparison in efficacy of catheter ablation for elderly versus non-elderly patients with persistent atrial fibrillation

Abstract Background/Introduction Atrial fibrillation (AF) is common arrythmia among elderly patients. Advancing age is reportedly associated with left atrium (LA) fibrosis and remodeling. We hypothesized that an extensive ablation strategy in addition to pulmonary vein isolation (PVI-plus) might be effective for elderly patients, whereas the PVI alone strategy (PVI-alone) might be sufficient for young patients to maintain sinus rhythm. Purpose We investigated the efficacy of ablation strategy (PVI-alone or PVI-plus) for AF patients stratified by age. Methods This study is a post-hoc analysis of the EARNEST-PVI trial. The EARNEST-PVI trial was a prospective, multicenter, randomized, and open-label non-inferiority trial comparing PVI-alone vs PVI-plus in patients with persistent AF. The primary endpoint was recurrence of AF. Results A total of 497 patients were eligible and divided into two groups (elderly group (age≥65, n=291) or young group (age<65, n=206)). In elderly group, the event rate was significantly lower in the PVI-plus group than in the PVI-alone group (Hazard ratio (HR): 0.587, 95% confidence interval (CI): 0.406 – 0.849, P = 0.0047), while the event rate was similar between both groups in young group (HR: 1.101, 95%CI: 0.687 - 1.77, P = 0.692) (P for interaction: 0.0411). Conclusion In elderly patients, PVI-plus strategy was more effective than PVI-alone, whereas the PVI alone strategy was sufficient for young patients.