Efficacy and safety of the second generation cryoballoon ablation for the treatment of paroxysmal atrial fibrillation in patients over 75 years: a comparison with a younger cohort

Introduction The prevalence of atrial fibrillation (AF) increases with age. Although the efficacy of cryoballoon ablation (CB‐A) in patients with AF has been demonstrated, data on the efficacy of this CB‐A in elderly patients are limited. The aim of this study was to evaluate the 1‐year efficacy and safety of CB‐A in patients aged ≥80 years compared with those less than 80 years. Methods A total of 49 consecutive patients ≥80 years with paroxysmal AF (PAF) who underwent CB‐A were compared with 241 patients aged <80 years. AF‐free survival rate at 1 year and procedural data were compared between the groups. Results Median (25th, 75th quartile) age was 83 (82, 85) years in the older group and 68 (61, 73) years in the younger group. At 1‐year follow‐up, the success rate did not significantly differ between the groups. In Cox regression analysis, age ≥80 years was not significantly related to AF recurrence. Low‐voltage areas were more frequently observed in the elderly group than the control group (39% vs 17%; P = .01). Fluoroscopy time and procedure time did not differ significantly. There was no significant difference in the occurrence rate of transient phrenic nerve palsy. No severe complications occurred in either group, including procedure‐related deaths, atrioesophageal fistula, cardiac tamponade, and cerebrovascular embolic events. Conclusion The results of our study showed that CB‐A for PAF is a feasible and safe procedure even in elderly patients, with similar success and complication rates when compared with a younger population.

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 95%

Efficacy and safety of the cryoballoon‐based atrial fibrillation ablation in patients aged ≥80 years

Kanda

Masuda

Kurata

et al. 2019

“…3 Considerable advancements in technology, techniques, and periprocedural management alongside increasing institutional experience are assumed to have yielded improvements in safety. [5][6][7] Interestingly, a recent cohort study found that despite an observed reduction in complication rates, novel catheter technology, and DOACs were not associated with an appreciable improvement in safety. 1 Examples of advancements include the introduction of direct oral anticoagulants (DOACs), uninterrupted procedural anticoagulation, the use of ultrasound for direct femoral access, cryoablation, and the introduction of force-sensing catheters.…”

Section: Introductionmentioning

confidence: 99%

Temporal trends in safety and complication rates of catheter ablation for atrial fibrillation

Muthalaly

John

Schaeffer

et al. 2018

“…Through a mean follow‐up time of 15.1 ± 8.2 months, CBA produced promising results, with 1‐year and 2‐year freedom from AF rates of 86.4% and 80.2%, respectively . These findings were further supported by the study by Juan‐Pablo Abugattas et al, which was the first comparative study including 106 younger and 53 older patients and also showed comparable efficacy (success rate 84.9 vs 81.1%, P = .54) and safety through 1 year of follow‐up after CBA in the two age groups . Evidence from Europe supported favorable outcomes of CBA in geriatric patients, but there have only been limited published results of the outcomes of CBA in China, especially in elderly Chinese patients.…”

Section: Discussionmentioning

confidence: 55%

“…The first study of CBA in elderly patients showed freedom from AF recurrence rate of 86.4% at 12 months and 80.2% at 24 months, which agreed with the freedom rate reported in the general population. Thereafter, the first comparative study of paroxysmal AF patients indicated similar success and complication rates in elderly and younger patients . Although preliminary evidence has shown the safety and efficacy of CBA for geriatric patients, the retrospective design and heterogeneity of the populations limit the conclusions.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of cryoballoon ablation for Chinese patients over 75 years old: A comparison with a younger cohort

Zhang

Ren

Wang

et al. 2019

Introduction Cryoballoon ablation (CBA) results in satisfactory outcomes for drug‐resistant atrial fibrillation (AF) patients. However, the efficacy and safety of CBA have not yet been tested in the Chinese elderly population. Therefore, this study compared the recurrence of AF and complications of CBA in patients ≥75 years and <75 years. Methods A total of 677 patients (<75 years, n = 550; ≥ 75 years, n = 127) with paroxysmal (n = 603) or persistent (n = 74) non‐valvular drug‐resistant AF were included. The efficacy was assessed by the recurrence of AF, and the safety was evaluated by peri‐ and post‐procedural complications. Results The CHA2DS2‐VASc (2.6 ± 1.7 vs 4.8 ± 1.6, P < .01) and HAS‐BLED (1.8 ± 0.8 vs 2.0 ± 0.8, P = .01) scores were significantly higher in the elderly group. The instant pulmonary vein isolation success rate was comparable (99.11% younger vs 98.98% older, P = .99). After a mean follow‐up time of 12.8 ± 9.6 months, the 1‐year freedom from AF rate was 80.6% vs 85.8% in the older and younger groups, respectively, while the survival analysis showed a nonsignificant difference in the rate of freedom from AF (log‐rank P = .46). Cox regression showed that age was not a predictive factor for AF recurrence and was not dichotomized (hazard ratio [HR] = 0.868, 95% confidence interval [CI] 0.509‐1.481; P = .6046) or continuous (HR = 0.990, 95% CI, 0.968‐1.012, P = .3642). Similar complications rates were observed, including stroke (1.0% younger vs 0.93% older, P = .95) and major hemorrhagic events (1.2% younger vs 0% elder, P = .25). Conclusions The efficacy and safety profiles of CBA in patients older than 75 years are comparable with those in younger patients.