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What is the age cutoff and other exclusion criteria for ablations?

Posted by riverpark @riverpark, Apr 5 7:40am

Hi friends,

I haven’t posted in 3 years but follow and benefit from your these discussions frequently. I am 78 yo man, active, diagnosed paroxysmal AF 4 years ago, “palpitations” all my life . One 2-hr AF event and one 40-min event that resolved on their own in last year, but several seconds-long, short-running variety of arrhythmias day in and day out. Take 75 mg Flecainide twice daily and 25 mg metoprolol succinate once daily. Just completed 14-day heart monitor and then a long video consult with cardiologist mainly because I have felt like I have the flu since I began the AF meds and explored with him any alternative to taking Flecainide and metoprolol. My health provider here in California has 70 as age cut off for ablations, but cardiologist says because of my activity level, trim weight, healthful diet, and no other health problems, he will refer me to electrophysiologist for ablation consideration, despite my age. But first, have an echocardiogram. So yesterday I had my third echocardiogram with these comments just now automatically emailed to me:

“Left Ventricle: Left ventricle size is normal. Mild concentric hypertrophy present. Normal systolic function with an estimated EF of 60 - 65%. • Right Ventricle: Right ventricle size is normal. Normal systolic function. • Left Atrium: Left atrium is moderately dilated.”

The CONCENTRIC HYPERTROPHY and LEFT ATRIUM MODERATELY DILATED are new since last echocardiogram in 2023. It is Saturday morning and won’t likely get comments and advice from cardiology for another week. So does anybody know if these changes are something of major concern? And do you think their presence will remove me as a possible candidate for ablation?
Thank you very much for any comments you might have!

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amu45sin | @amu45sin | Apr 10 2:27pm
In reply to @suerte "I am on Medicare with a supplemental insurance from Blue Cross Blue Shield. My costs are..." + (show)
@suerte

I am on Medicare with a supplemental insurance from Blue Cross Blue Shield. My costs are minimal with a very low onetime deductible. My only costs after that are for a procedure that is required that is not covered by Medicare. I have only had a few of these and the costs were very low. My costs for a Pulse Field Ablation at UC Health will be zero or very, very little. Prescriptions are a different matter, and the only expensive prescription is Eliquis.

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Thanks. &Hugz

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riverpark | @riverpark | Apr 10 6:20pm
In reply to @JustinMcClanahan "@riverpark, It sounds like you got a bit more confidence from the experiences of @suerte, @harveywj,..." + (show)
@JustinMcClanahan

@riverpark, It sounds like you got a bit more confidence from the experiences of @suerte, @harveywj, @kudzu, @dandl48, @lhesse and the scientific resources from @gloaming.

You may notice I updated the title of the discussion to focus on the topic of whether there are exclusion criteria for older adults regarding ablation.

@riverpark, if you are a deemed a candidate for an ablation by your electrophysiologist at your upcoming appointment, would you have any concerns about moving forward with that procedure?

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Hi Justin,
If deemed a candidate, I definitely would have concerns over whether or not to go through with it rather than stick with meds. But I’d need much more info from the electrophysiologist than I have now to make that decision, including info about how my age might factor into everything during and after the procedure.

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cstrutt52 | @cstrutt52 | Apr 11 10:21am

I'm 72 and just had my first PF ablation (Feb 20). It was not a big deal at all. There was never any mention of limiting factors. I am active, at weight, and otherwise healthy. It seems to be working. I had 59 AFib events in 2024 lasting 20+ hours each.

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1 reply
joaf37 | @joaf37 | Apr 11 2:05pm
In reply to @suerte "I am 85 and yesterday I had a telehealth appointment with an electrophysiologist from the University..." + (show)
@suerte

I am 85 and yesterday I had a telehealth appointment with an electrophysiologist from the University of Colorado and he said that I am a perfect candidate for Pulse Field Ablation. Right now, just waiting to set up a date for the procedure. I am active, but only through the daily routine of dealing with the chores associated with caring for my small ranch and large animals.

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I have been exploring this option with more than one major health care facility no mention of age limit at all. Not sure how insurance would play into this which may be the reason for varying views on this.

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amu45sin | @amu45sin | Apr 11 7:50pm
In reply to @riverpark "I have no idea of their reasoning, but my cardiologist first told me that Kaiser Permanente..." + (show)
@riverpark

I have no idea of their reasoning, but my cardiologist first told me that Kaiser Permanente has a standard age cut-off of 70 for ablations but that I nevertheless would be an acceptable candidate at age 79 because of my active lifestyle, trim BMI, and otherwise good health.

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I am with Kaiser in Denver , am 79, and have an ablation scheduled in a week (4/18).

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bigheart | @bigheart | Apr 12 10:15am
In reply to @cstrutt52 "I'm 72 and just had my first PF ablation (Feb 20). It was not a big..." + (show)
@cstrutt52

I'm 72 and just had my first PF ablation (Feb 20). It was not a big deal at all. There was never any mention of limiting factors. I am active, at weight, and otherwise healthy. It seems to be working. I had 59 AFib events in 2024 lasting 20+ hours each.

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I have been in afib for 33 days, non-stop. I've had the watchman, ablation, cardiovert and was good for three months - then bingo! Here we go again.

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yogal | @yogal | Apr 12 5:30pm

I'm 86 years old and recently had a PFA Star Appolo mapping (AI) six weeks ago. I believe it depends on the individual's health and activity level.

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