J Arrhythm. 2026 Sep 25;42(5):e70461. doi: 10.1002/joa3.70461. eCollection 2026 Oct.
ABSTRACT
INTRODUCTION: Chronological age is often considered when selecting patients for atrial fibrillation (AF) ablation, but age alone may not identify which older patients are most likely to require recurrent rhythm-related care after pulmonary vein isolation (PVI).
METHODS: We conducted a single-center observational study of consecutive patients undergoing PVI. The principal registry cohort assessed the same-center recurrence-related rhythm-intervention endpoint, defined as the first post-index repeat PVI or electrical cardioversion. A nested active 2022 cohort assessed broader actively ascertained recurrence. Age was analyzed as < 50, 50-74, and ≥ 75. An exploratory elderly vulnerability score assigned one point each for documented persistent AF, heart failure, chronic kidney disease, and valve disease/surgery.
RESULTS: The registry cohort included 2559 patients and 580 same-center rhythm-intervention events. Event rates increased across age groups: 14.2% in patients aged < 50, 20.8% in those aged 50-74, and 29.8% in those aged ≥ 75. Age ≥ 75 was independently associated with higher risk versus age 50-74 in adjusted registry Cox analysis, HR: 1.35, 95% CI: 1.12-1.64, p = 0.002, after 90-day blanking, HR: 1.37, 95% CI: 1.12-1.69, p = 0.002, and in the active cohort, HR: 1.46, 95% CI: 1.01-2.11, p = 0.042. Elderly Score 0 patients were not significantly different from patients aged 50-74 in registry analysis, aHR: 1.13, 95% CI: 0.79-1.63, p = 0.5, or active analysis, aHR: 1.01, 95% CI: 0.49-2.09, p = 0.975, whereas Score ≥ 2 identified higher event burden in both the registry cohort, aHR: 1.85, 95% CI: 1.45-2.35, p < 0.001, and active cohort, aHR: 1.95, 95% CI: 1.23-3.12, p = 0.005.
CONCLUSION: Age ≥ 75 was associated with a higher rate of same-center recurrence-related rhythm interventions after PVI, but the risk varied substantially. Clinical vulnerability, not chronological age alone, may better inform counseling and selection of older patients.
PMID:42801084 | PMC:PMC13615338 | DOI:10.1002/joa3.70461