Arrhythmias & electrophysiology

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

Heart RhythmPublished Retrospective analysis

Main finding · Atrial tachyarrhythmia recurrenceResult — go to the resultHazard ratio 0.76 95% CI 0.65–0.89

Authors' conclusion

CA treatment was associated with a lower risk of atrial tachyarrhythmia, cardioversion, HF hospitalization, and ischemic stroke than AADs. AADs were poorly tolerated in this cohort, and complication rates from CA were similar to those of younger groups. Favorable safety and efficacy support consideration of CA in elderly patients.

Study context

Population
Elderly patients (aged ≥65 years) with drug-refractory atrial fibrillation (AF), Optum Clinformatics database, 2016 to 2022patients identified
Participants
13,311 patients
Exposure
Catheter ablation (CA) with AADs
  • CA cohortn = 6,081
  • AAD cohortn = 7,230reference
Outcome
Atrial tachyarrhythmia recurrence
Methodological detailspropensity score matching
  • Propensity score matching

Main finding

As reported in the abstract

Hazard ratio

0.76

95% CI 0.65–0.89

CA cohortvs AAD cohort
HR 0.76 (95% CI 0.65–0.89)

Observational data: associations, not effects.

Secondary outcomes

OutcomeHR (95% CI)
Direct current cardioversion0.74 (0.60–0.91)
HF hospitalization0.63 (0.45–0.90)
Ischemic stroke0.45 (0.28–0.72)

Death or myocardial infarction

Without differences in death or myocardial infarction

Safety

OutcomeCA cohortAAD cohort
Complications (CA) / adverse events (AAD)rate of complications 5.9%adverse events 45.4%

Original publication

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. Heart Rhythm. Published 6 March 2026. doi:10.1016/j.hrthm.2026.02.045

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