The only variable affecting success rate was type of AF with persistent afibbers having a 64% greater risk of AF recurrence when compared to paroxysmal afibbers.
The authors point out that most young afibbers would be reluctant to take antiarrhythmics for decades and suggest that catheter ablation should be first-line therapy for afibbers below the age of 45 years as for this age group the outcome is very favorable and complications rare.
In an accompanying editorial, Drs. Hugh Calkins and David Edwards disagree with this conclusion and maintain that antiarrhythmic therapy should be considered first-line treatment in all age groups. Leong-Sit, P, et al. Efficacy and risk of atrial fibrillation ablation before 45 years of age. Circulation: Arrhythmia and Electrophysiology, Vol. 3, October 2010, pp. 452-57
Edwards, DN and Calkins, H. Should catheter ablation of atrial fibrillation be a first-line therapy in the young? Circulation: Arrhythmia and Electrophysiology, Vol. 3, October 2010, pp. 425-27 Editor's comment
: The suggestion that catheter ablation should be first-line treatment for afibbers below the age of 45 years is well supported by the data presented in the report. However, there is still no data as to how permanent the effects of a successful ablation are. Is a successfully ablated afibber likely to still be in sinus rhythm 10 years after the procedure? Nobody knows! On the other hand, there is now evidence that antiarrhythmic therapy is less effective than ablation in most cases (52% vs. 77%) and it is also well established that antiarrhythmics, especially amiodarone can have serious long-term adverse effects. Nevertheless, I personally would be reluctant to jump straight to an ablation, even at age 45 years, without having thoroughly explored other options such as those outlined in my 12-step plan
The complete success rate for afibbers 65 years or older is clearly inferior to that observed for younger individuals (45 years or younger). However, members of the older group had several disadvantages when compared to the younger group:
- Higher percentage of females (success rates for females are notoriously lower)
- Higher percentage of persistent afibbers
- Higher incidence of hypertension, diabetes and heart failure
- Less use of repeat procedures.
Thus it is quite possible that success rates for older afibbers with paroxysmal AF and without comorbid conditions would be very close to that found for younger individuals if the use of repeat procedures was equal in the two groups. Calkins, H, et al. Treatment of atrial fibrillation with antiarrhythmic drugs or radiofrequency ablation: two systematic literature reviews and meta-analyses. Circulation: Arrhythmia and Electrophysiology, Vol. 2, 2009, pp. 349-61