Antiarrhythmic drugs vs catheter ablation for treatment of atrial fibrillation in an elderly population: A retrospective analysis of Medicare Advantage enrollees in the United States

BACKGROUND Catheter ablation (CA) is a widely utilized therapy for atrial fibrillation (AF), but limited research compares the effectiveness of CA with anti-arrhythmic drugs (AADs) in an elderly population. OBJECTIVE Compare AF recurrence and other clinical outcomes for CA versus AADs in an elderly population with drug-refractory AF. METHODS A large-nationally representative sample of elderly patients (≥ 65 years) was studied using the Optum Clinformatics database from 2016 to 2022. The primary outcome was atrial tachyarrhythmia recurrence. Secondary outcomes included electrical cardioversions (DCCV), heart failure (HF) hospitalizations, myocardial infarctions (MI), ischemic strokes, and death. Propensity score-matching was used to balance cohorts. RESULTS 13,311 patients were identified, with 7,230 in the AAD cohort and 6,081 in the CA cohort. Patients who underwent CA were 24% less likely to experience recurrence compared to those treated with AADs (hazard ratio HR: 0.76, 95% confidence interval CI: 0.65-0.89). The risk of DCCV (HR: 0.74, 95% CI: 0.60-0.91), HF hospitalization (HR: 0.63, 95% CI: 0.45-0.90), and ischemic stroke (HR: 0.45, 95% CI: 0.28-0.72) was significantly reduced, without differences in death or MI. The rate of complications was 5.9% in the CA cohort, while adverse events were frequent in the AAD cohort (45.4%). CONCLUSION CA treatment was associated with lower risk of atrial tachyarrhythmia, cardioversion, HF hospitalization, and ischemic stroke compared to AADs. AADs were poorly tolerated in this cohort and complication rates from CA were similar to younger groups. Favorably safety and efficacy supports consideration of CA in elderly patients.