Background: The incidence and prevalence of atrial fibrillation (AF) increases significantly with age. Catheter ablation is an established treatment option for rhythm control therapy. However, data regarding the outcome of catheter ablation in octogenarians is scarce.

Methods: Patients with symptomatic paroxysmal, persistent, and long-standing persistent AF aged ≥80 years undergoing catheter ablation, including first and re-ablation procedures in a single centre, were analysed retrospectively. Catheter ablation involved pulmonary vein isolation (PVI) using radiofrequency (RF), cryoballoon (CB) and pulsed field ablation (PFA) as energy sources but also consecutive atrial tachycardia (AT) ablation including atrial lines and/or ablation of complex fractionated atrial electrograms (CFAE) in persistent AF. Acute success (complete isolation of all pulmonary veins and/or non-inducibility in atrial tachycardia) and complications (classified as life-threatening, severe, and minor/moderate) were recorded. Follow-up (FU) was obtained to assess arrhythmia-free survival, recurrence, and management of recurrences.

Results: A total of 126 patients (mean age 82.2 ± 1.9 years) were included. 57.1% (n=72/126) patients underwent a first-do procedure {47.2% (n=34/72) RF PVI, 37.5% (n=27/72) CB PVI, 4.2% (n=3/72) PFA PVI and 11.1% (n=8/72) PVI + additional AT ablation}. 42.9% (n=54/126) patients received redo procedures {20.4% (n=11/54) Re-PVI, 42.6% (n=23/54) Re-PVI + AT ablation, 37% (n=20/54) AT ablation}. Acute success was achieved in 99.2% (n=125/126). Life-threatening complications occurred in 2.4% {0.8% (n=1/126) stroke, 1.6% (n=2/126) tamponade}, severe complications in 0.8% {0.8% (n=1/126) phrenic nerve palsy} and minor/moderate complications in 7.9% {2.4% (n=3/126) bradycardia with pacemaker implantation, 1.6% (n=2/126) pneumonia, 2.4% (n=3/126) urinary tract infection and 1.6% (n=2/126) acute kidney injury}. FU after 15.4 ± 3.6 months revealed arrhythmia-free survival in 64.2% (n=70/109). Recurrence after the blanking period was seen in 34.9% (n=38/109). Management of recurrence involved repeat ablation (47%, n=18/38), antiarrhythmic medication (16%, n=6/38), cardioversion (21%, n=8/38), pacemaker-implantation/AV-node ablation (5%, n=2/38) and pharmacological rate control (11%, n=4/38).

Conclusions: Catheter ablation for AF in octogenarians shows favourable acute success and low life-threatening/severe complication rates. Several combined measures (repeat ablation, antiarrhythmic therapy, cardioversion) may be required to achieve long-term arrhythmia-free survival in this patient population. Long term success of catheter ablation and superiority to rate control in this patient population is unknown and requires investigation in the future.