RESUMO
BACKGROUND: Catheter ablation (CA) is a well-established therapy for patients with atrial fibrillation (AF); however, there is paucity of data for elderly patients. We aimed to assess long-term efficacy and safety of CA for elderly patients with AF. METHODS: Medline, BVS, Cochrane, and Embase were searched through April 2023 to investigate comparative outcomes between elderly patients > 75 or 80 years, as per-study cutoff, and individuals ≤ 75/80 years, undergoing CA. Primary efficacy and safety endpoints (AF recurrence and procedure-related major complications) were pooled with the Comprehensive Meta-Analysis 3.0 software. Subgroup analyses were performed by age groups and type of procedure (radiofrequency vs. cryoballoon). RESULTS: Four thousand eight hundred twenty-nine titles were screened, and 27 studies were included, being 26 observational and 1 randomized trial, comprising 117,869 patients, being 8714 (7.4%) elderly > 75/80 years, with follow-up from 11.7 to 72.3 months. In comparative studies (N = 17 studies), elderly > 75/80 years had a higher risk of AF recurrence compared to those ≤ 75/80: relative risk (RR) 1.16 (95% CI 1.05-1.27, p = 0.002. However, funnel plot indicated publication bias, and after imputation of 5 studies, the groups were similar (RR 1.07 (95% CI 0.97-1.19)). The rates of major complications (N = 14 studies) were higher in elderly > 75/80 years (RR 1.30 (95% CI 1.10-1.54), I2 = 0, p = 0.002), but were similar in cryoablation studies (N = 7) (RR 1.10, 95% CI 0.94-1.29, p = 0.24, I2 = 0.0). Results were similar when individual study arms (N = 27 studies) were pooled. CONCLUSION: AF ablation is feasible in elderly patients > 75/80 years, with success rates compared to younger individuals. Complication rates, however, were higher.
Assuntos
Cardiomiopatia Hipertrófica/cirurgia , Septos Cardíacos/cirurgia , Próteses Valvulares Cardíacas , Estenose da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Idoso , Cardiomiopatia Hipertrófica/complicações , Ecocardiografia Transesofagiana , Feminino , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Estenose da Valva Mitral/etiologia , ReoperaçãoRESUMO
Mulher de 67 anos de idade, apresentando estenose mitral grave, não-reumática, após 18 anos da realização de miotomia/miectomia septal cirúrgica para correção de miocardiopatia hipertrófica septal assimétrica. A paciente foi submetida a troca da valva mitral por prótese mecânica, tornando-se caso único, em razão da combinação das duas síndromes, extremamente rara e com grave prognóstico.