Research Paper Volume 15, Issue 15 pp 7343—7361

Cardiovascular events and death after catheter ablation in very old patients with nonvalvular atrial fibrillation

Keisuke Okawa1, , Satoshi Taya1, , Takeshi Morimoto2, , Ryu Tsushima1, , Yuya Sudo1, , Ai Sakamoto1, , Eisuke Saito1, , Masahiro Sogo1, , Masatomo Ozaki1, , Masahiko Takahashi1, ,

  • 1 Department of Cardiovascular Medicine, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa 760-8557, Japan
  • 2 Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Hyogo 663-8501, Japan

Received: November 12, 2022       Accepted: July 14, 2023       Published: August 14, 2023
How to Cite

Copyright: © 2023 Okawa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Background: Catheter ablation of atrial fibrillation (AF) is recommended for selected older patients. However, the preventive effects of AF ablation on cardiovascular events and death remain unclear, especially in older patients. This study aimed to investigate the impact of AF ablation on the incidence of cardiovascular events and death in very old nonvalvular AF (NVAF) patients.

Methods: We conducted a prospective cohort study of consecutive patients with NVAF aged ≥80 years and using direct oral anticoagulants (DOACs). We defined cardiovascular events as acute heart failure (AHF), strokes and systemic embolisms (SSEs), acute coronary syndrome (ACS), and sudden cardiac death (SCD) and cardiovascular death as AHF/SSE/ACS-related death and SCD. We compared the 3-year incidence of cardiovascular events and death between the patients who underwent AF ablation (Ablation group) and those who received medical therapy only (Medication group).

Results: Among the 782 NVAF patients using DOACs, propensity score matching provided 208 patients in each group. The Ablation group had a significantly lower 3-year incidence of cardiovascular events and death than the Medication group: cardiovascular events, 24 (13.2%) vs. 43 (23.3%), log-rank P = 0.009 and hazard ratio (HR) 0.52 (95% confidence interval (CI) 0.32–0.86) and cardiovascular deaths, 5 (3.0%) vs. 15 (7.8%), log-rank P = 0.019 and HR 0.32 (95% CI 0.16–0.88).

Conclusions: In very old NVAF patients using DOACs, those who underwent AF ablation had a lower incidence of both cardiovascular events and death than those who received medical therapy only.


AF: Atrial fibrillation; ACS: Acute coronary syndrome; AHF: Acute heart failure; DOAC: Direct oral anticoagulant; HR: Hazard ratio; NVAF: Nonvalvular atrial fibrillation; LA: Left atrium; LVEF: Left ventricular ejection fraction; SCD: Sudden cardiac death; SSE: Stroke and systemic embolism; TTE: Transthoracic echocardiography.