Catheter Ablation Outcomes and Life Expectancy in Very Elderly Atrial Fibrillation Patients: The REHEALTH AF Study

Shu Hirata; Yasuo Okumura; Koichi Nagashima; Ryuta Watanabe; Katsuaki Yokoyama; Naoya Matsumoto; Takeshi Kato; Hidehira Fukaya; Hidemori Hayashi; Shiro Nakahara; Wataru Shimizu; Yu ki Iwasaki; Yuhi Fujimoto; Yasushi Mukai; Koichiro Ejima; Takayuki Otsuka; Shinya Suzuki; Masato Murakami; Masaomi Kimura; Masahide Harada; Junjiroh Koyama; Teiichi Yamane; Michifumi Tokuda; Mitsuru Takami; Morio Shoda; Tomoo Harada; Ikutaro Nakajima; Kenichi Hiroshima; Kojiro Tanimoto; Koji Kumagai; Ayako Okada; Hideki Kobayashi; Yuji Watari; Mina Hatsuno; Tatsuya Hayashi; Eizo Tachibana; Kazuki Iso; Kazumasa Sonoda; Yoshiyasu Aizawa; Ryoma Fukuoka; Akio Chikata; Masaru Inoue; Satoru Sakagami; Hitoshi Minamiguchi; Nobuhiko Makino; Makoto Ichikawa; Hironori Haruta; Takafumi Hiro; Kimie Okubo; Masaru Arai; Ken Arima; Hajime Kihara; Satoru Miyanaga; Yoshiaki Fukuda; Koji Oiwa; Yutaka Koyama; Tamami Kurihara; Masashi Akabane; Norikazu Ishikawa; Kengo Kusano; Koji Miyamoto; Haruna Tabuchi; Tomoyuki Shiozawa; Kenjiro Miyamoto; Hiroshi Mase; Kenta Murotani

doi:10.1016/j.jacep.2025.10.007

Catheter Ablation Outcomes and Life Expectancy in Very Elderly Atrial Fibrillation Patients: The REHEALTH AF Study

Shu Hirata
, Yasuo Okumura
, Koichi Nagashima
, Ryuta Watanabe
, Katsuaki Yokoyama
, Naoya Matsumoto
, Takeshi Kato
, Hidehira Fukaya
, Hidemori Hayashi
, Shiro Nakahara
, Wataru Shimizu
, Yu ki Iwasaki
, Yuhi Fujimoto
, Yasushi Mukai
, Koichiro Ejima
, Takayuki Otsuka
, Shinya Suzuki
, Masato Murakami
, Masaomi Kimura
, Masahide Harada

Junjiroh Koyama, Teiichi Yamane, Michifumi Tokuda, Mitsuru Takami, Morio Shoda, Tomoo Harada, Ikutaro Nakajima, Kenichi Hiroshima, Kojiro Tanimoto, Koji Kumagai, Ayako Okada, Hideki Kobayashi, Yuji Watari, Mina Hatsuno, Tatsuya Hayashi, Eizo Tachibana, Kazuki Iso, Kazumasa Sonoda, Yoshiyasu Aizawa, Ryoma Fukuoka, Akio Chikata, Masaru Inoue, Satoru Sakagami, Hitoshi Minamiguchi, Nobuhiko Makino, Makoto Ichikawa, Hironori Haruta, Takafumi Hiro, Kimie Okubo, Masaru Arai, Ken Arima, Hajime Kihara, Satoru Miyanaga, Yoshiaki Fukuda, Koji Oiwa, Yutaka Koyama, Tamami Kurihara, Masashi Akabane, Norikazu Ishikawa, Kengo Kusano, Koji Miyamoto, Haruna Tabuchi, Tomoyuki Shiozawa, Kenjiro Miyamoto, Hiroshi Mase, Kenta Murotani

Division of Cardiology

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

Abstract

Background: Evidence regarding the benefits of catheter ablation in patients aged ≥80 years with nonvalvular atrial fibrillation (AF) remains limited. Objectives: This study sought to evaluate the clinical effectiveness of catheter ablation compared with conservative management in elderly patients (age ≥80 years) with nonvalvular AF. Methods: This prospective, registry-based, multicenter observational study involved 703 patients aged ≥80 years with nonvalvular AF enrolled from 47 hospitals in Japan (June 2022-December 2023). Among them, 249 underwent catheter ablation and 454 received nonablation management. Results: The nonablation group was slightly older, with more comorbidities and modestly worse baseline characteristics; however, most were potential ablation candidates, and the differences were small. During a median follow-up of 504 days (Q1-Q3: 375-667 days), the primary outcome (a composite of stroke, transient ischemic attack, systemic embolism, cardiovascular events, bleeding, or all-cause death) did not differ between groups in the unmatched (HR: 0.78; P = 0.30) or matched (HR: 0.65; P = 0.21) cohorts. However, in the matched cohort, multivariable adjustment for log-N-terminal pro–B-type natriuretic peptide and albumin levels showed a significant benefit of ablation (adjusted HR: 0.44; P = 0.029). At 1 year, ablation improved symptoms, quality of life, N-terminal pro–B-type natriuretic peptide levels, and left atrial diameter, as well as better preservation of Mini–Mental State Examination and frailty scores. These benefits remained significant after adjustment. Conclusions: The REHEALTH AF Study (Registry for Evaluating Healthy Life Expectancy and Long-Term Outcomes After Catheter Ablation of Atrial Fibrillation in the Very Elderly) study is the first prospective comparison of ablation vs nonablation in patients aged ≥80 years with AF. Although ablation improved functional and structural outcomes, its prognostic benefit was limited without adjustment but emerged after multivariable correction. Ablation may offer meaningful advantages in well-selected elderly patients, supporting individualized treatment strategies.

Original language	English
Pages (from-to)	307-321
Number of pages	15
Journal	JACC: Clinical Electrophysiology
Volume	12
Issue number	2
DOIs	https://doi.org/10.1016/j.jacep.2025.10.007
Publication status	Published - 02-2026

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

All Science Journal Classification (ASJC) codes

Cardiology and Cardiovascular Medicine
Physiology (medical)

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10.1016/j.jacep.2025.10.007

Cite this

Hirata, S., Okumura, Y., Nagashima, K., Watanabe, R., Yokoyama, K., Matsumoto, N., Kato, T., Fukaya, H., Hayashi, H., Nakahara, S., Shimizu, W., Iwasaki, Y. K., Fujimoto, Y., Mukai, Y., Ejima, K., Otsuka, T., Suzuki, S., Murakami, M., Kimura, M., ... Murotani, K. (2026). Catheter Ablation Outcomes and Life Expectancy in Very Elderly Atrial Fibrillation Patients: The REHEALTH AF Study. JACC: Clinical Electrophysiology, 12(2), 307-321. https://doi.org/10.1016/j.jacep.2025.10.007

@article{7686c99f63214deea9a0d8b76af09860,

title = "Catheter Ablation Outcomes and Life Expectancy in Very Elderly Atrial Fibrillation Patients: The REHEALTH AF Study",

abstract = "Background: Evidence regarding the benefits of catheter ablation in patients aged ≥80 years with nonvalvular atrial fibrillation (AF) remains limited. Objectives: This study sought to evaluate the clinical effectiveness of catheter ablation compared with conservative management in elderly patients (age ≥80 years) with nonvalvular AF. Methods: This prospective, registry-based, multicenter observational study involved 703 patients aged ≥80 years with nonvalvular AF enrolled from 47 hospitals in Japan (June 2022-December 2023). Among them, 249 underwent catheter ablation and 454 received nonablation management. Results: The nonablation group was slightly older, with more comorbidities and modestly worse baseline characteristics; however, most were potential ablation candidates, and the differences were small. During a median follow-up of 504 days (Q1-Q3: 375-667 days), the primary outcome (a composite of stroke, transient ischemic attack, systemic embolism, cardiovascular events, bleeding, or all-cause death) did not differ between groups in the unmatched (HR: 0.78; P = 0.30) or matched (HR: 0.65; P = 0.21) cohorts. However, in the matched cohort, multivariable adjustment for log-N-terminal pro{\textendash}B-type natriuretic peptide and albumin levels showed a significant benefit of ablation (adjusted HR: 0.44; P = 0.029). At 1 year, ablation improved symptoms, quality of life, N-terminal pro{\textendash}B-type natriuretic peptide levels, and left atrial diameter, as well as better preservation of Mini{\textendash}Mental State Examination and frailty scores. These benefits remained significant after adjustment. Conclusions: The REHEALTH AF Study (Registry for Evaluating Healthy Life Expectancy and Long-Term Outcomes After Catheter Ablation of Atrial Fibrillation in the Very Elderly) study is the first prospective comparison of ablation vs nonablation in patients aged ≥80 years with AF. Although ablation improved functional and structural outcomes, its prognostic benefit was limited without adjustment but emerged after multivariable correction. Ablation may offer meaningful advantages in well-selected elderly patients, supporting individualized treatment strategies.",

keywords = "atrial fibrillation, catheter ablation, clinical outcomes, octogenarians, quality of life",

author = "Shu Hirata and Yasuo Okumura and Koichi Nagashima and Ryuta Watanabe and Katsuaki Yokoyama and Naoya Matsumoto and Takeshi Kato and Hidehira Fukaya and Hidemori Hayashi and Shiro Nakahara and Wataru Shimizu and Iwasaki, \{Yu ki\} and Yuhi Fujimoto and Yasushi Mukai and Koichiro Ejima and Takayuki Otsuka and Shinya Suzuki and Masato Murakami and Masaomi Kimura and Masahide Harada and Junjiroh Koyama and Teiichi Yamane and Michifumi Tokuda and Mitsuru Takami and Morio Shoda and Tomoo Harada and Ikutaro Nakajima and Kenichi Hiroshima and Kojiro Tanimoto and Koji Kumagai and Ayako Okada and Hideki Kobayashi and Yuji Watari and Mina Hatsuno and Tatsuya Hayashi and Eizo Tachibana and Kazuki Iso and Kazumasa Sonoda and Yoshiyasu Aizawa and Ryoma Fukuoka and Akio Chikata and Masaru Inoue and Satoru Sakagami and Hitoshi Minamiguchi and Nobuhiko Makino and Makoto Ichikawa and Hironori Haruta and Takafumi Hiro and Kimie Okubo and Masaru Arai and Ken Arima and Hajime Kihara and Satoru Miyanaga and Yoshiaki Fukuda and Koji Oiwa and Yutaka Koyama and Tamami Kurihara and Masashi Akabane and Norikazu Ishikawa and Kengo Kusano and Koji Miyamoto and Haruna Tabuchi and Tomoyuki Shiozawa and Kenjiro Miyamoto and Hiroshi Mase and Kenta Murotani",

note = "Publisher Copyright: {\textcopyright} 2026 American College of Cardiology Foundation",

year = "2026",

month = feb,

doi = "10.1016/j.jacep.2025.10.007",

language = "English",

volume = "12",

pages = "307--321",

journal = "JACC: Clinical Electrophysiology",

issn = "2405-500X",

publisher = "Elsevier Inc.",

number = "2",

}

Hirata, S, Okumura, Y, Nagashima, K, Watanabe, R, Yokoyama, K, Matsumoto, N, Kato, T, Fukaya, H, Hayashi, H, Nakahara, S, Shimizu, W, Iwasaki, YK, Fujimoto, Y, Mukai, Y, Ejima, K, Otsuka, T, Suzuki, S, Murakami, M, Kimura, M, Harada, M, Koyama, J, Yamane, T, Tokuda, M, Takami, M, Shoda, M, Harada, T, Nakajima, I, Hiroshima, K, Tanimoto, K, Kumagai, K, Okada, A, Kobayashi, H, Watari, Y, Hatsuno, M, Hayashi, T, Tachibana, E, Iso, K, Sonoda, K, Aizawa, Y, Fukuoka, R, Chikata, A, Inoue, M, Sakagami, S, Minamiguchi, H, Makino, N, Ichikawa, M, Haruta, H, Hiro, T, Okubo, K, Arai, M, Arima, K, Kihara, H, Miyanaga, S, Fukuda, Y, Oiwa, K, Koyama, Y, Kurihara, T, Akabane, M, Ishikawa, N, Kusano, K, Miyamoto, K, Tabuchi, H, Shiozawa, T, Miyamoto, K, Mase, H & Murotani, K 2026, 'Catheter Ablation Outcomes and Life Expectancy in Very Elderly Atrial Fibrillation Patients: The REHEALTH AF Study', JACC: Clinical Electrophysiology, vol. 12, no. 2, pp. 307-321. https://doi.org/10.1016/j.jacep.2025.10.007

TY - JOUR

T1 - Catheter Ablation Outcomes and Life Expectancy in Very Elderly Atrial Fibrillation Patients

T2 - The REHEALTH AF Study

AU - Hirata, Shu

AU - Okumura, Yasuo

AU - Nagashima, Koichi

AU - Watanabe, Ryuta

AU - Yokoyama, Katsuaki

AU - Matsumoto, Naoya

AU - Kato, Takeshi

AU - Fukaya, Hidehira

AU - Hayashi, Hidemori

AU - Nakahara, Shiro

AU - Shimizu, Wataru

AU - Iwasaki, Yu ki

AU - Fujimoto, Yuhi

AU - Mukai, Yasushi

AU - Ejima, Koichiro

AU - Otsuka, Takayuki

AU - Suzuki, Shinya

AU - Murakami, Masato

AU - Kimura, Masaomi

AU - Harada, Masahide

AU - Koyama, Junjiroh

AU - Yamane, Teiichi

AU - Tokuda, Michifumi

AU - Takami, Mitsuru

AU - Shoda, Morio

AU - Harada, Tomoo

AU - Nakajima, Ikutaro

AU - Hiroshima, Kenichi

AU - Tanimoto, Kojiro

AU - Kumagai, Koji

AU - Okada, Ayako

AU - Kobayashi, Hideki

AU - Watari, Yuji

AU - Hatsuno, Mina

AU - Hayashi, Tatsuya

AU - Tachibana, Eizo

AU - Iso, Kazuki

AU - Sonoda, Kazumasa

AU - Aizawa, Yoshiyasu

AU - Fukuoka, Ryoma

AU - Chikata, Akio

AU - Inoue, Masaru

AU - Sakagami, Satoru

AU - Minamiguchi, Hitoshi

AU - Makino, Nobuhiko

AU - Ichikawa, Makoto

AU - Haruta, Hironori

AU - Hiro, Takafumi

AU - Okubo, Kimie

AU - Arai, Masaru

AU - Arima, Ken

AU - Kihara, Hajime

AU - Miyanaga, Satoru

AU - Fukuda, Yoshiaki

AU - Oiwa, Koji

AU - Koyama, Yutaka

AU - Kurihara, Tamami

AU - Akabane, Masashi

AU - Ishikawa, Norikazu

AU - Kusano, Kengo

AU - Miyamoto, Koji

AU - Tabuchi, Haruna

AU - Shiozawa, Tomoyuki

AU - Miyamoto, Kenjiro

AU - Mase, Hiroshi

AU - Murotani, Kenta

PY - 2026/2

Y1 - 2026/2

N2 - Background: Evidence regarding the benefits of catheter ablation in patients aged ≥80 years with nonvalvular atrial fibrillation (AF) remains limited. Objectives: This study sought to evaluate the clinical effectiveness of catheter ablation compared with conservative management in elderly patients (age ≥80 years) with nonvalvular AF. Methods: This prospective, registry-based, multicenter observational study involved 703 patients aged ≥80 years with nonvalvular AF enrolled from 47 hospitals in Japan (June 2022-December 2023). Among them, 249 underwent catheter ablation and 454 received nonablation management. Results: The nonablation group was slightly older, with more comorbidities and modestly worse baseline characteristics; however, most were potential ablation candidates, and the differences were small. During a median follow-up of 504 days (Q1-Q3: 375-667 days), the primary outcome (a composite of stroke, transient ischemic attack, systemic embolism, cardiovascular events, bleeding, or all-cause death) did not differ between groups in the unmatched (HR: 0.78; P = 0.30) or matched (HR: 0.65; P = 0.21) cohorts. However, in the matched cohort, multivariable adjustment for log-N-terminal pro–B-type natriuretic peptide and albumin levels showed a significant benefit of ablation (adjusted HR: 0.44; P = 0.029). At 1 year, ablation improved symptoms, quality of life, N-terminal pro–B-type natriuretic peptide levels, and left atrial diameter, as well as better preservation of Mini–Mental State Examination and frailty scores. These benefits remained significant after adjustment. Conclusions: The REHEALTH AF Study (Registry for Evaluating Healthy Life Expectancy and Long-Term Outcomes After Catheter Ablation of Atrial Fibrillation in the Very Elderly) study is the first prospective comparison of ablation vs nonablation in patients aged ≥80 years with AF. Although ablation improved functional and structural outcomes, its prognostic benefit was limited without adjustment but emerged after multivariable correction. Ablation may offer meaningful advantages in well-selected elderly patients, supporting individualized treatment strategies.

AB - Background: Evidence regarding the benefits of catheter ablation in patients aged ≥80 years with nonvalvular atrial fibrillation (AF) remains limited. Objectives: This study sought to evaluate the clinical effectiveness of catheter ablation compared with conservative management in elderly patients (age ≥80 years) with nonvalvular AF. Methods: This prospective, registry-based, multicenter observational study involved 703 patients aged ≥80 years with nonvalvular AF enrolled from 47 hospitals in Japan (June 2022-December 2023). Among them, 249 underwent catheter ablation and 454 received nonablation management. Results: The nonablation group was slightly older, with more comorbidities and modestly worse baseline characteristics; however, most were potential ablation candidates, and the differences were small. During a median follow-up of 504 days (Q1-Q3: 375-667 days), the primary outcome (a composite of stroke, transient ischemic attack, systemic embolism, cardiovascular events, bleeding, or all-cause death) did not differ between groups in the unmatched (HR: 0.78; P = 0.30) or matched (HR: 0.65; P = 0.21) cohorts. However, in the matched cohort, multivariable adjustment for log-N-terminal pro–B-type natriuretic peptide and albumin levels showed a significant benefit of ablation (adjusted HR: 0.44; P = 0.029). At 1 year, ablation improved symptoms, quality of life, N-terminal pro–B-type natriuretic peptide levels, and left atrial diameter, as well as better preservation of Mini–Mental State Examination and frailty scores. These benefits remained significant after adjustment. Conclusions: The REHEALTH AF Study (Registry for Evaluating Healthy Life Expectancy and Long-Term Outcomes After Catheter Ablation of Atrial Fibrillation in the Very Elderly) study is the first prospective comparison of ablation vs nonablation in patients aged ≥80 years with AF. Although ablation improved functional and structural outcomes, its prognostic benefit was limited without adjustment but emerged after multivariable correction. Ablation may offer meaningful advantages in well-selected elderly patients, supporting individualized treatment strategies.

KW - atrial fibrillation

KW - catheter ablation

KW - clinical outcomes

KW - octogenarians

KW - quality of life

UR - https://www.scopus.com/pages/publications/105026275666

UR - https://www.scopus.com/pages/publications/105026275666#tab=citedBy

U2 - 10.1016/j.jacep.2025.10.007

DO - 10.1016/j.jacep.2025.10.007

M3 - Article

C2 - 41288543

AN - SCOPUS:105026275666

SN - 2405-500X

VL - 12

SP - 307

EP - 321

JO - JACC: Clinical Electrophysiology

JF - JACC: Clinical Electrophysiology

IS - 2

ER -

Catheter Ablation Outcomes and Life Expectancy in Very Elderly Atrial Fibrillation Patients: The REHEALTH AF Study

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