Heart rhythm · 2026
Antiarrhythmic drugs vs catheter ablation for treatment of atrial fibrillation in an elderly population: A retrospective analysis of Medicare Advantage enrollees in the United States.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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D'Angelo Robert N, Rong Yiran, Khanna Rahul, Locke Andrew, Iglesias Maximiliano, d'Avila Andre, Zimetbaum Peter J
Аннотация
BACKGROUND: Catheter ablation (CA) is a widely used therapy for atrial fibrillation (AF), but limited research compares the effectiveness of CA with antiarrhythmic drugs (AADs) in an elderly population.
OBJECTIVE: This study aimed to compare AF recurrence and other clinical outcomes for CA with AADs in an elderly population with drug-refractory AF.
METHODS: A large nationally representative sample of elderly patients (aged ≥65 years) was studied using the Optum Clinformatics database from 2016 to 2022. The primary outcome was atrial tachyarrhythmia recurrence. Secondary outcomes included direct current cardioversions, heart failure (HF) hospitalizations, myocardial infarctions, ischemic strokes, and death. Propensity score matching was used to balance cohorts.
RESULTS: 13,311 patients were identified, with 7230 in the AAD cohort and 6081 in the CA cohort. Patients who underwent CA were 24% less likely to experience recurrence compared with those treated with AADs (hazard ratio [HR] 0.76; 95% confidence interval [CI] 0.65-0.89). The risk of direct current cardioversion (HR 0.74; 95% CI 0.60-0.91), HF hospitalization (HR 0.63; 95% CI 0.45-0.90), and ischemic stroke (HR 0.45; 95% CI 0.28-0.72) was significantly reduced, without differences in death or myocardial infarction. The rate of complications was 5.9% in the CA cohort, whereas adverse events were frequent in the AAD cohort (45.4%).
CONCLUSION: CA treatment was associated with a lower risk of atrial tachyarrhythmia, cardioversion, HF hospitalization, and ischemic stroke than AADs. AADs were poorly tolerated in this cohort, and complication rates from CA were similar to those of younger groups. Favorable safety and efficacy support consideration of CA in elderly patients.
OBJECTIVE: This study aimed to compare AF recurrence and other clinical outcomes for CA with AADs in an elderly population with drug-refractory AF.
METHODS: A large nationally representative sample of elderly patients (aged ≥65 years) was studied using the Optum Clinformatics database from 2016 to 2022. The primary outcome was atrial tachyarrhythmia recurrence. Secondary outcomes included direct current cardioversions, heart failure (HF) hospitalizations, myocardial infarctions, ischemic strokes, and death. Propensity score matching was used to balance cohorts.
RESULTS: 13,311 patients were identified, with 7230 in the AAD cohort and 6081 in the CA cohort. Patients who underwent CA were 24% less likely to experience recurrence compared with those treated with AADs (hazard ratio [HR] 0.76; 95% confidence interval [CI] 0.65-0.89). The risk of direct current cardioversion (HR 0.74; 95% CI 0.60-0.91), HF hospitalization (HR 0.63; 95% CI 0.45-0.90), and ischemic stroke (HR 0.45; 95% CI 0.28-0.72) was significantly reduced, without differences in death or myocardial infarction. The rate of complications was 5.9% in the CA cohort, whereas adverse events were frequent in the AAD cohort (45.4%).
CONCLUSION: CA treatment was associated with a lower risk of atrial tachyarrhythmia, cardioversion, HF hospitalization, and ischemic stroke than AADs. AADs were poorly tolerated in this cohort, and complication rates from CA were similar to those of younger groups. Favorable safety and efficacy support consideration of CA in elderly patients.