Atrial fibrillation ablation in octogenarians: where do we stand?

The prevalence of atrial fibrillation increases significantly with age, affecting nearly 10 % of adults greater than 80 years of age. Complications from atrial fibrillation, including stroke, also increase with age. Medical therapy includes anticoagulation, ventricular rate control, and if symptoms persist, maintenance of sinus rhythm with antiarrhythmic drugs. However, anticoagulation and antiarrhythmic therapy is often challenging in the elderly due to side effects, comorbidities, and heightened sensitivity to medications. Catheter based ablation of atrial fibrillation is an effective treatment for paroxysmal atrial fibrillation. However, the major randomized controlled trials, such as Thermocool AF and STOP-AF studies, have excluded the elderly patients. Current guidelines suggest caution when considering ablation for elderly patients due to a lack of available data. We will review recent studies that have observed the outcomes of atrial fibrillation ablation in the elderly, specifically those studies that included octogenarians.