Abstract 19189: Long-term Outcomes of Catheter Ablation of Atrial Fibrillation in Elderly Patients
Bibliographic record
Abstract
Introduction: Atrial fibrillation (AF) is highly prevalent in the elderly. Our aim is to evaluate the safety and efficacy of catheter ablation (PVI) in this population. Hypothesis: Catheter ablation(PVI) for AF is less effective in the elderly population. Methods: Data of 6824 consecutive patients who had PVI between January 2006 and July 2013 were reviewed. Patients ≥ 75 years were included in the study. Ablation strategy included isolation of all pulmonary veins as well as left atrial(LA) substrate modification as needed. Procedural complications and success (defined as freedom from any atrial arrhythmia lasting more than 30 seconds) were analyzed. Results: This study included 402 consecutive patients who underwent 452 ablation procedures. Of those patients, 76 were ≥ 80 years old. The mean age was 77.6 ± 2.5. 166 (41%) were female, and 148 (37%) had persistent AF. The median lifetime AF duration was 5 years (IQR: 2.5, 10). The mean CHADS2-VASC was 3.47 ± 2 and mean LV EF was 55.3% ± 9.1. 90% of patients were anticoagulated with warfarin, 8% with dabigatran, 2% with rivaroxaban, and 1 with enoxaparin. 28% of patients were also on aspirin and 2% on clopidogrel. Median follow up period was 394 days (IQR: 182, 777). Major complications included 1 ischemic stroke, 5 cases of tamponade during ablation, 8 cases of groin hematoma that required intervention, and 1 case of hemothorax. Minor complications included 8 small hematomas, and 1 hemodynamically stable pericardial effusion. After a single ablation, 154 (38.3%) patients remained arythmia free. 118 (29.3%) had infrequent paroxysmal AF, 39 (9.7%) had persistent AF, 42 (10.4%) had paroxysmal AF and AFL/AT, and 14 (3.5%) had persistent AF and AFL/AT. 9 (2.2%) had AT/AFL only. 21 (5.2%) patients had incomplete follow up. Five (1.2%) procedures were aborted; 4 due to complications with trans-septal puncture, and 1 due to electric silence of the LA. 50 patients underwent repeat ablation, increasing the freedom of AF to 42.0% Conclusions: AF ablation in the elderly is associated with a minimal increase in complications, most commonly in the form of access site hematoma. However, success rates are lower than that previously reported in younger patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".