Should Concomitant Surgical Ablation for Atrial Fibrillation Be Performed in Patients Aged Over 75 Years?

Introduction: The incidence of atrial fibrillation (AF) increases with age, and therefore many elderly patients presenting for cardiac surgery suffer from AF. In recent publications, increasing age has been recognized as a predictor for ablation failure. Furthermore, many surgeons are reluctant to perform a surgical ablation in elderly patients. We therefore investigated the safety and efficacy of concomitant surgical AF ablation in patients aged over 75 years.

Methods: Between 2003 and 2013 605 patients underwent concomitant surgical AF ablation in our institution. 154 patients were older than 75 years at time of surgical ablation and were included in this retrospective data analysis. Rhythm monitoring by either 24h-Holter ECG (n = 103) or Implantable loop recorder (ILR) (n = 51). Logistic regression analysis was used to identify predictors for rhythm outcome. Primary endpoint of the study was freedom from AF at 12 months follow-up.

Results: Mean patients age was 78.2±2.6 years, 59.0% were male. There were no major ablation-related complications. 30-day and 1-year survival rate was 96.3% and 93.5% respectively. 3 (1.9%) patients experienced perioperative stroke. Permanent pacemaker implantation rate was 8.4%. Freedom from AF at 1-year follow up was 63.3%. Statistically significant predictors for successful ablation were preoperative paroxysmal AF, shorter duration of AF and smaller LA diameter.

Conclusion: In patients aged over 75 years surgical AF ablation was safe and effective without ablation- related complications. Freedom from AF rate was 63.3% at 1-year follow-up. Predictors for successful ablation were preoperative paroxysmal AF, shorter AF duration and smaller LA diameter. Therefore, concomitant atrial ablation is recommended in this patient group.