Catheter Ablation Outcomes and Life Expectancy in Very Elderly Atrial Fibrillation Patients: The REHEALTH AF Study.

BACKGROUND

Evidence regarding the benefits of catheter ablation in patients aged ≥80 years with nonvalvular atrial fibrillation (AF) remains limited.

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).