Relationship between catheter ablation of atrial fibrillation and cardiovascular prognosis in elderly patients

Li Sitong; Zhao Meiqi; Li Mingxiao; He Liu; Zhou Ning; Sang Caihua; Ma Changsheng

doi:10.3760/j.issn.1673-4777.2025.10.001

Abstract：Objective To evaluate the efficacy of catheter ablation for atrial fibrillation in elderly patients.Methods Patients aged 75 years or older were enrolled from the China Atrial Fibrillation Registry Study from August 2011 to December 2022.Patients were divided into ablation group and non-ablation group according to whether they received ablation at baseline.The primary endpoint was the composite endpoint of cardiovascular death and cardiovascular hospitalization.The secondary endpoints included cardiovascular death,cardiovascular hospitalization,embolic events and recurrence of atrial fibrillation.The Kaplan-Meier method was used to draw the survival curve.Multivariate Cox regression and overlapping weighted analysis were used to evaluate the relationship between ablation and endpoint.Results A total of 2 912 patients were enrolled,including 976 in the ablation group and 1 936 in the non-ablation group.Survival curve analysis showed that the risk of cardiovascular death or cardiovascular hospitalization in the ablation group was lower than that in the non-ablation group(hazard ratio=0.68,95％confidence interval:0.60-0.76,Log-rank P＜0.001).During the follow-up of 35.2(14.7,64.5)months,1 418 patients had cardiovascular death or cardiovascular hospitalization,and the incidence was 13.7/100 patient-years.The incidence was 10.4/100 patient-years in the ablation group and 15.2/100 patient-years in the non-ablation group.Catheter ablation was associated with a significantly lower composite risk of cardiovascular death or cardio-vascular hospitalization after adjustment for confounders(hazard ratio=0.82,95％confidence interval:0.72-0.93,P=0.003),with similar results in overlap-weighted analyses.In addition,catheter ablation was signifi-cantly associated with reduced risks of cardiovascular death(hazard ratio=0.38,overlap-weighted hazard ratio=0.35,both P＜0.001)and recurrence of atrial fibrillation(hazard ratio=0.30,overlap-weighted hazard ratio=0.28,both P＜0.001).Conclusion In older patients with atrial fibrillation,catheter ablation is associated with a lower risk of cardiovascular death or cardiovascular hospitalization and a lower risk of atrial fibrillation recurrence.