Efficacy and safety of high‐power short duration atrial fibrillation ablation in elderly patients

Abstract

Introduction: Data about atrial fibrillation (AF) ablation using high-power short duration (HPSD) radiofrequency ablation in the elderly population is still scarce. The aim of our study was to investigate the efficacy and safety of HPSD ablation in patients over 75 years compared to younger patients.Methods: Consecutive patients older than 75 years with paroxysmal or persistent AF undergoing a first-time AF ablation using 50 W HPSD ablation approach were analyzed in this retrospective observational analysis and compared to a control group <75 years. Short-term endpoints included intraprocedural reconnection of at least one pulmonary vein (PV) and intrahospital and AF recurrence during 3 months blanking period, as well as a long-term endpoint of freedom from atrial arrhythmias of antiarrhythmic drugs after 12 months.Results: A total of 540 patients underwent a first AF ablation with HPSD (66 ± 10 years; 58% male; 47% paroxysmal AF). Mean age was 78 ± 2.4 and 63 ± 6.3 years (p < .001), respectively. Elderly patients were significantly more often women (p < .001). The procedure, fluoroscopy, and ablation were comparable. Elderly patients revealed significantly more often extra-PV lowvoltage areas requiring additional left atrial ablations (p < .001). Overall complication rates were low; however, elderly patients revealed higher major complication rates mainly due to unmasking sick sinus syndrome (p = .003).Freedom from arrhythmia recurrences was comparable (68% vs. 76%, log-rank p = .087). Only in the subgroup of paroxysmal AF, AF recurrences were more common after 12 months (69% vs. 82%; log-rank p = .040; hazard ratio: 1.462, p = .044) in the elderly patients. In multivariable Cox regression analysis of the whole cohort persistent AF, female gender, diabetes mellitus and presence of left atrium low-voltage areas, but not age >75 years were associated with AF recurrences.Conclusion: HPSD AF ablation of patients >75 years in experienced centers is safe and effective. Therefore, age alone should not be the reason to withhold AF ablation

Safety and efficacy of ablation index‐guided atrial fibrillation ablation in octogenarians

“…Several studies have reported that RF catheter ablation for AF was safe and effective in elderly patients 9,13–19 . The safety and efficiency of AF patients aged >75 years were reported in the year of 2008 13 and those aged >80 years in the years of 2010 14 and 2012 15 .…”

“…In 2015, Nademanee et al reported that catheter ablation for AF was associated with lower late stroke and bleeding event rates in patients aged >75 16 . These reports analyzed the results from ablation procedures that employed the technologies before the introduction of the latest ones, such as contact force‐sensing catheter 6–8 and quantitative ablation lesion size marker AI 9 …”

“…However, the mean age of the patients included in this study was 59 years, and not necessarily evaluated the efficacy in very elderly patients aged ≥80 years. Müller et al reported that AI‐guided, high‐power short‐duration RF applications (50 W and AI 350–400 for posterior wall ablation, 50 W and AI 450 for anterior wall ablation) safely and effectively completed AF ablation in elderly patients older than 75 years (mean age, 78 ± 2.8 years) 9 . Our present study compared the AT recurrence‐free survival rate and complications of AI‐guided AF ablation between the patient groups aged ≥80 years and <80 years and showed similar AT recurrence‐free survival rate and complication rate between the two groups even after adjustment of AF type.…”

“…16 These reports analyzed the results from ablation procedures that employed the technologies before the introduction of the latest ones, such as contact force-sensing catheter [6][7][8] and quantitative ablation lesion size marker AI. 9 AI-guided ablation incorporating a contact force sensing catheter has been shown to create complete durable PVI and improve the outcome of AF ablation. Taghji et al proposed the CLOSE protocol, applying the contiguous AI-guided RF enclosing the PV.…”

“…Also, AI‐guided, high‐power RF application was the technical method to shorten the procedure time 8 . Recently, AI‐guided high‐power RF catheter ablation for elderly AF patients older than 75 was reported to be safe and effective 9 . However, limited data on the efficacy and safety of AI‐guided ablation procedures for very elderly AF patients have been available.…”