Efficacy and safety of cryoballoon ablation in the elderly: A multicenter study.

BACKGROUND: The prevalence of atrial fibrillation (AF) increases with age. Second-generation cryoballoon (CB2)-based PVI has demonstrated encouraging clinical results in the treatment of paroxysmal (PAF) and persistent atrial fibrillation (PersAF). The objective of this study was to assess data on safety, efficacy and long-term clinical success of CB2-based pulmonary vein isolation (PVI) in patients ≥75 years of age. METHODS: CB2-based PVI was performed in 104 patients ≥75 years of age (elderly group) and symptomatic AF (PersAF: n = 44, 42.3%) in three highly experienced German EP centers. The data was compared to propensity score matched patients with age <75 years (n = 104, control group; PersAF: n = 45, 43.3%, p = 0.956). RESULTS: The median age of the elderly group was 77.5 [75, 80] years while it was 63 [52, 70] years of control group patients (p = 0.0001). The median procedure time was 92.5 [75, 120] minutes (elderly group) and 100 [75, 120] (control group), p = 0.124. Major complications were registered in 7/104 (6.7%) elderly patients and 7/104 (6.7%) control group patients (p = 0.999). Clinical success in terms of freedom from AF recurrence after one-year follow-up was 80% (95% CI: 72-88) and 82% (95% CI: 75-90) and after three-year follow-up 59% (95% CI: 47-74) and 49% (95% CI: 37 64) for the elderly group and the control group, respectively (p = 0.7). CONCLUSIONS: CB2-based PVI in patients ≥75 years of age appears safe, is associated with low procedure times and shows promising clinical success rates equal to patients of the younger population.

Ablation of atrial fibrillation in patients ≥75 years: long-term clinical outcome and safety.

AIMS: The prevalence of atrial fibrillation (AF) increases with age. Catheter ablation is an established treatment option for patients with symptomatic AF. We sought to determine the safety and long-term clinical efficacy of AF ablation in patients ≥75 years. METHODS AND RESULTS: Patients ≥75 years with symptomatic, drug-refractory AF were included in the study. Circumferential pulmonary vein isolation (PVI) was performed in all patients, extended to ablation of complex fractionated atrial electrograms, and/or linear lesions in PVI non-responders. Retrospective follow-up (FU) was based on routine outpatient clinic visits and regular telephone interviews. A total of 94 patients (54 male, age 78 ± 2 years, and left atrium diameter 46 ± 6 mm) with drug-refractory AF [55/94 (59%) paroxysmal AF (PAF), 29/94 (31%) persistent AF, and 10/94 (11%) long-standing persistent AF] underwent ablation. Follow-up was obtained in 93/94 (99%) patients. Following a single procedure, 35/93 (38%) patients were in stable sinus rhythm (SR; 46% PAF, 31% persistent AF, and 10% long-standing persistent AF) after a mean FU of 37 ± 20 months. After a mean of 1.5 ± 0.6 procedures, 55/93 (59%) patients were ultimately in stable SR (76% PAF, 41% persistent AF, and 20% long-standing persistent AF). In a total of 137 procedures, 8 major (5.8%) and 26 minor (19%) complications occurred. CONCLUSIONS: Catheter ablation in patients ≥75 years is associated with a favourable clinical long-term outcome in patients with PAF, while results are less promising in persistent or long-standing persistent patients. The safety profile of AF ablation in patients ≥75 years is comparable with patients of younger age.