Catheter ablation of atrial fibrillation in the elderly

The incidence and prevalence of atrial fibrillation (AF) increase with age. Catheter ablation has been suggested to improve the quality of life of patients with AF. However, in order to expand the indications for AF ablation to the elderly, several important questions should be answered as to whether safety and efficacy of AF ablation in elderly patients are similar to those in younger populations, whether the AF mechanisms in elderly patients are similar to those in younger patients so that the same ablation techniques can be used in both groups, and whether anticoagulation strategies should be the same for elderly patients as for younger patients after AF ablation. Recent studies reported that the risk of complications from AF ablation did not vary with age, nor was the AF recurrence rate age-dependent for any type of AF, suggesting that the AF mechanisms in elderly patients were similar to those in younger patients. On the other hand, the feasibility of discontinuation of anticoagulation in the elderly after successful AF ablation has not been established since it is difficult to be certain whether AF has been truly cured and since many elderly people are likely to be considered as high-risk based on their CHADS₂ score. In addition, the elderly patients who have been included in published trials of AF ablation may not represent an unselected population of individuals in this age group. Randomized trials of catheter ablation will be necessary before this procedure can be promoted for wider use in the elderly.