ORAL COMMUNICATION | Rhythm control strategy and outcomes in very elderly atrial fibrillation patients: an analysis of the nationwide Italian START registry

Background. Researchers have limited evidence on antiarrhythmic drug (AAD) use in very elderly patients with atrial fibrillation (AF). We investigated clinical characteristics and outcomes associated with AAD use in this population.

Materials and Methods. 4,244 very elderly (age ≥80 years) AF patients from the nationwide START registry were included. Patients were divided into 3 groups: no AADs (n=3,573), class 1c-AAD (n=207), and amiodarone (n=464). Risks of all-cause mortality and cardiovascular events (CVEs) were analyzed according to AAD.

Results. The mean age was 84.8±3.8 years; 54.9% were women. AADs were used in 15.8% of patients. The use of Class 1c-AADs was directly associated with paroxysmal AF and inversely associated with older age, female sex, diabetes, heart failure, digoxin, COPD/OSAS, beta-blockers, and lack of familial/social support. Amiodarone use was directly associated with paroxysmal AF, coronary artery disease, and wheelchair use and inversely associated with age, peripheral artery disease, living alone, digoxin use, beta-blockers, and lack of familial/social support. Over a mean follow-up of 685.6±537.7 days, 492 all-cause deaths and 548 CVE events occurred. In univariable Cox analysis, Class 1c AADs were associated with lower mortality (HR 0.371, 95% CI 0.191-0.717) and CVEs (sHR 0.443, 95% CI 0.250-0.786), while amiodarone was not. These associations did not persist in multivariable analysis.

Conclusions. Among very elderly AF patients, the choice of rhythm control strategy is influenced by frailty elements. AADs use was not associated with better survival.