Catheter ablation has become an established treatment option for symptomatic atrial fibrillation (AF), yet comparative evidence between ablation and antiarrhythmic drug therapy in elderly populations remains limited. A retrospective cohort analysis published in the Heart Rhythm examined the effectiveness and safety of catheter ablation (CA) compared with antiarrhythmic drugs (AADs) in patients aged 65 years or older with drug-refractory AF.

The study used the Optum Clinformatics database to identify a nationally representative cohort of elderly patients treated between 2016 and 2022. Patients receiving CA were compared with those treated with AADs. Propensity score matching was applied to balance baseline characteristics between treatment groups. The primary outcome was recurrence of atrial tachyarrhythmia. Secondary outcomes included direct-current cardioversion (DCCV), hospitalization for Heart Failure, Myocardial Infarction, ischemic stroke, and all-cause mortality.

A total of 13,311 patients were included, with 7,230 receiving AAD therapy and 6,081 undergoing CA. Patients treated with CA had a lower risk of atrial tachyarrhythmia recurrence compared with those receiving AADs (hazard ratio [HR] 0.76; 95% CI 0.65–0.89). CA was also associated with lower risks 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). There were no significant differences between groups in rates of death or MI.

Complications occurred in 5.9% of patients undergoing CA, while adverse events were reported in 45.4% of patients receiving AAD therapy.

In this elderly cohort with drug-refractory AF, catheter ablation was associated with lower recurrence and several adverse cardiovascular outcomes compared with antiarrhythmic drug therapy. Safety outcomes were comparable to previously reported ablation experiences.