Anticoagulant Therapy and Risk of Cerebrovascular Events After Catheter Ablation of Atrial Fibrillation in the Elderly

Stroke and Atrial Fibrillation Ablation. Introduction: Factors associated with cerebrovascular events (CVEs) after radiofrequency catheter ablation (RFA) of atrial fibrillation (AF) have not been well defined in elderly patients (>= 65 years). The purpose of this study was to determine the prevalence and predictors of CVEs after RFA in patients with AF >= 65 years old, in comparison to patients <65 years, and with or without AF. Methods and Results: This study included 508 consecutive patients >= 65 years old (mean age: 70 +/- 4 years), who underwent RFA for paroxysmal (297) or persistent (211) AF. A stratified group of 508 patients < 65 years old who underwent RFA for AF served as a control group. All patients were anticoagulated with warfarin for >= 3 months after RFA. A perioperative CVE (<= 4 weeks after RFA) occurred in 0.8% and 1% of patients >= 65 and <65 years old, respectively (P = 1). Among the patients >= 65 years old who remained in sinus rhythm after RFA, warfarin was discontinued in 60% and 56% of the patients with a CHADS(2) score of 0 and >= 1, respectively. Paroxysmal AF, no history of CVE, and successful RFA were independent predictors of discontinuing warfarin. During a mean follow- up of 3 +/- 2 years, a late CVE (> 4 weeks after the RFA) occurred in 15 of 508 (3%) of patients >= 65 years old (1% per year) and in 5 of 508 (1%) patients < 65 years old (0.3% per year, P = 0.03). Among patients >= 65 years old, age > 75 years old (OR = 4.9, +/- 95% CI: 3.3- 148.5, P = 0.001) was the only independent predictor of a CVE. Among patients < 65 years old, body mass index was the only independent predictor of a late CVE (OR = 1.2, +/- 95% CI: 1.03- 1.33, P = 0.02). Conclusions: The risk of a periprocedural CVE after RFA of AF is similar among patients >= 65 and < 65 years old. Late CVEs after RFA are more prevalent in older than younger patients with AF, and age > 75 years old is the only independent predictor of late CVEs regardless of the rhythm, anticoagulation status, or the CHADS(2) score (Congestive heart failure, Hypertension, Age = 75 years, Diabetes mellitus and prior Stroke or transient ischemic attack). (J Cardiovasc Electrophysiol, Vol. 23, pp. 36-43, January 2012)