Catheter Ablation Outcomes and Life Expectancy in Very Elderly Atrial Fibrillation Patients: The REHEALTH AF Study.
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Hirata Shu, Okumura Yasuo, Nagashima Koichi, Watanabe Ryuta, Yokoyama Katsuaki, Matsumoto Naoya, Kato Takeshi, Fukaya Hidehira, Hayashi Hidemori, Nakahara Shiro, Shimizu Wataru, Iwasaki Yu-Ki, Fujimoto Yuhi, Mukai Yasushi, Ejima Koichiro, Otsuka Takayuki, Suzuki Shinya, Murakami Masato, Kimura Masaomi, Harada Masahide, Koyama Junjiroh, Yamane Teiichi, Tokuda Michifumi, Takami Mitsuru, Shoda Morio, Harada Tomoo, Nakajima Ikutaro, Hiroshima Kenichi, Tanimoto Kojiro, Kumagai Koji, Okada Ayako, Kobayashi Hideki, Watari Yuji, Hatsuno Mina, Hayashi Tatsuya, Tachibana Eizo, Iso Kazuki, Sonoda Kazumasa, Aizawa Yoshiyasu, Fukuoka Ryoma, Chikata Akio, Inoue Masaru, Sakagami Satoru, Minamiguchi Hitoshi, Makino Nobuhiko, Ichikawa Makoto, Haruta Hironori, Hiro Takafumi, Okubo Kimie, Arai Masaru, Arima Ken, Kihara Hajime, Miyanaga Satoru, Fukuda Yoshiaki, Oiwa Koji, Koyama Yutaka, Kurihara Tamami, Akabane Masashi, Ishikawa Norikazu, Kusano Kengo, Miyamoto Koji, Tabuchi Haruna, Shiozawa Tomoyuki, Miyamoto Kenjiro, Mase Hiroshi, Murotani Kenta
Аннотация
OBJECTIVES: This study sought to evaluate the clinical effectiveness of catheter ablation compared with conservative management in elderly patients (age ≥80 years) with nonvalvular AF.
METHODS: This prospective, registry-based, multicenter observational study involved 703 patients aged ≥80 years with nonvalvular AF enrolled from 47 hospitals in Japan (June 2022-December 2023). Among them, 249 underwent catheter ablation and 454 received nonablation management.
RESULTS: The nonablation group was slightly older, with more comorbidities and modestly worse baseline characteristics; however, most were potential ablation candidates, and the differences were small. During a median follow-up of 504 days (Q1-Q3: 375-667 days), the primary outcome (a composite of stroke, transient ischemic attack, systemic embolism, cardiovascular events, bleeding, or all-cause death) did not differ between groups in the unmatched (HR: 0.78; P = 0.30) or matched (HR: 0.65; P = 0.21) cohorts. However, in the matched cohort, multivariable adjustment for log-N-terminal pro-B-type natriuretic peptide and albumin levels showed a significant benefit of ablation (adjusted HR: 0.44; P = 0.029). At 1 year, ablation improved symptoms, quality of life, N-terminal pro-B-type natriuretic peptide levels, and left atrial diameter, as well as better preservation of Mini-Mental State Examination and frailty scores. These benefits remained significant after adjustment.
CONCLUSIONS: The REHEALTH AF Study (Registry for Evaluating Healthy Life Expectancy and Long-Term Outcomes After Catheter Ablation of Atrial Fibrillation in the Very Elderly) study is the first prospective comparison of ablation vs nonablation in patients aged ≥80 years with AF. Although ablation improved functional and structural outcomes, its prognostic benefit was limited without adjustment but emerged after multivariable correction. Ablation may offer meaningful advantages in well-selected elderly patients, supporting individualized treatment strategies. (Registry for Evaluating Healthy Life Expectancy and Long-Term Outcomes After Catheter Ablation of Atrial Fibrillation in the Very Elderly [REHEALTH AF]; UMIN000047023).