Chronological age was not independently associated with ultra-early safety or arrhythmic outcomes after contemporary atrial fibrillation ablation: a real-world single-center study

Background: Transcatheter ablation (TCA) is an established treatment for atrial fibrillation (AF); however, the impact of age on procedural safety and ultra-early arrhythmic outcomes remains incompletely understood, particularly in real-world clinical settings. Objective: To assess the association between age and early procedural safety and ultra-early arrhythmic outcomes following AF ablation in an unselected real-world cohort. Methods: We retrospectively analyzed 217 consecutive patients (mean age 67 +/- 9 years) who underwent transcatheter ablation for atrial fibrillation between January 2022 and December 2023 at a single tertiary center. Age was analyzed using three predefined cutoffs (< 65, < 70, and < 80 years) and as a continuous variable. Multivariable logistic regression analyses were performed to assess the independent association between age and procedural safety and ultra-early arrhythmic outcomes. The primary safety endpoint was a composite of pericardial effusion and/or cardiac tamponade confirmed by echocardiography, periprocedural bleeding requiring medical intervention or blood transfusion, stroke or transient ischemic attack (TIA), acute coronary events, cardiovascular or procedure-related death. The secondary arrhythmic endpoint was a composite of atrial fibrillation recurrence and AF persistence within 48 h. Both the composite endpoint and its individual components were evaluated in covariate-adjusted models. Results: No significant differences in early complications or arrhythmic outcomes were observed across the predefined age cutoffs. Multivariable logistic regression analysis showed that age was not independently associated with procedural safety (OR 0.99; 95% CI 0.93-1.06; p = 0.812), AF recurrence (OR 1.01; 95% CI 0.97-1.05; p = 0.77), or AF persistence (OR 1.00; 95% CI 0.96-1.05; p = 0.91). Conclusion: In this real-world, single-center cohort, age was not independently associated with procedural safety or ultra-early arrhythmic outcomes following AF ablation. These findings suggest that chronological age alone may not be a major determinant of ultra-early procedural outcomes in appropriately selected patients undergoing AF ablation.