Age-related and age-independent complications in atrial fibrillation ablation: insights from the Japan ablation registry

Abstract Background The growing prevalence of atrial fibrillation (AF) has intensified the focus on managing this condition in the elderly. Catheter ablation, a popular treatment option, requires more detailed examination due to limited data on its efficacy and risks in this age group. Aim To identify the types of complications of AF ablation correlated with advanced age and to differentiate them from age-independent complications. Method We conducted a prospective analysis of 170,017 AF ablation procedures from the Japan ablation registry, conducted across 482 facilities between 2017 and 2020. Complications in patients aged 80 and above (elderly group, n=14,389) were compared with those under 80 (control group, n=155,628). The overall complication rate was 2.77%, with a higher occurrence in the elderly group (elderly group vs. control group, 3.62% vs. 2.69%, p<0.001). Notably, the elderly experienced more cardiac tamponade/pericardial effusion (0.95% vs. 0.6%, p<0.001), symptomatic cerebral infarction or transient ischemic attacks (0.27% vs. 0.15%, p=0.001), and sick sinus syndrome (0.31% vs. 0.05%, p<0.001). While in-hospital mortality in the elderly group was relatively low (0.16%), it was significantly higher compared to the control group (0.06%, p<0.001). However, incidences of other complications like puncture-site complications (0.49% vs. 0.42%, p=0.28), non-puncture-site bleeding, esophagus-related complications (0.22% vs. 0.22%, p=0.72), and phrenic nerve palsy (0.44% vs. 0.43%, p=0.69) showed no significant age-related differences. Conclusion Elderly patients undergoing AF ablation are at a higher risk of overall complications, with particular susceptibility to cardiac tamponade/pericardial effusion, symptomatic cerebral infarction/transient ischemic attacks, and sick sinus syndrome. This highlights the need for careful monitoring of these specific complications in the elderly. Additionally, it is noteworthy that the risk of certain complications appears to be independent of age.