Arrhythmias & electrophysiologyCohort study
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
- Retrospective analysis
- propensity score matching
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 · AAD cohort 7,230 · catheter ablation (CA) cohort 6,081
- Participants
- 13,311 patients
- Exposure
- CA with AADs
- CA cohortn = 6,081
- AAD cohortn = 7,230reference
- Outcome
- Atrial tachyarrhythmia recurrence
Main finding
As reported in the abstract
Hazard ratio
0.76
95% CI 0.65–0.89
CA cohort vs AAD cohort
HR 0.76 (95% CI 0.65–0.89)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | HR (95% CI) | |
|---|---|---|
| Direct current cardioversion · significantly reduced | 0.74 (0.60–0.91) | |
| HF hospitalization · significantly reduced | 0.63 (0.45–0.90) | |
| Ischemic stroke · significantly reduced | 0.45 (0.28–0.72) | |
| 0.20.5125Hazard ratio (log scale) |
Death or myocardial infarction
- without differences in death or myocardial infarction
Safety
| Outcome | CA cohort | AAD 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
Summarised from the published abstract; every number is checked against it