Abstract 4370136: Beyond the Octogenarian Threshold: A Nationwide, Multicenter Three-Year Analysis of Post-Ablation Safety Outcomes in Elderly Atrial Fibrillation Patients

Background: Evidence on the safety of atrial fibrillation (AF) catheter ablation in U.S. patients over 80 years old remains limited. With growing life expectancy, more elderly individuals are being considered for this intervention, underscoring the need for age-specific safety data to guide clinical decision-making. Hypothesis: Elderly age is associated with increased procedural complications and mortality, suggesting a higher-risk profile and reduced safety. Aim: To provide critical insights into the real-world risks and complications. Methods: In this U.S.-based multicenter cohort study using the TriNetX dataset, we identified adults (≥ 60 years old) with new-onset AF and underwent catheter ablation within 6 months. Patients were categorized by age into first AF between 60 to 79 years old (defined as older adults), and first AF older than 80 years old (defined as elderly adults). Propensity score matching (1:1) balanced groups by demographics, comorbidities, and medications. The primary end point was the risk of repeat AF ablation at 3-year intervals. Secondary endpoints included new or ongoing antiarrhythmic (AAD) use, ischemic stroke, safety outcomes including heart failure (HF) exacerbations, composite pericardial complications, new venous thromboembolism (VTE), cardiac arrest, vascular access complications and all-cause hospitalizations, and all-cause death. Falsification outcomes included urinary tract infections (UTI) and herpes zoster. Kaplan-Meier analysis and log-rank tests compared outcomes; hazard ratios (HRs) with 95% CI were calculated using Cox regression. Results: After propensity score matching into well-balanced groups (N= 5,032 per group at 3-year follow-up), elderly adults were more likely to receive repeat catheter ablation. There were no differences between groups in AAD, VTE outcomes. Elderly adults were at higher risk of ischemic stroke (HR = 1.75, 95% CI = 1.52-2.02, p=0.002), new HF exacerbation (HR=1.75, 95% CI = 1.52-2.02, p<0.01), and new complete heart block or sick sinus syndrome (HR=1.85, 95% CI =1.59-2.16, p<0.01). Elderly adults were also more likely to encounter all-cause hospitalizations (HR=1.39-1.48, p<0.01) and all-cause death (HR=1.98, 95%CI=1.71-2.30, p<0.01). Conclusion: Elderly adults (≥80 years) undergoing AF ablation had significantly higher risk of complications than older adults (60-79 years). This underscore the importance of further investigations to ascertain the risk factors and potential development of screening tool.