Impact of age on the outcome of cryoballoon ablation as the primary approach in the interventional treatment of atrial fibrillation: Insights from a large all‐comer study

Abstract

Introduction The objective was to analyze the impact of patient age on clinical characteristics, procedural results, safety, and outcome of cryoballoon ablation (CBA) as the primary approach in the interventional treatment of symptomatic atrial fibrillation (AF). Methods and Results The single‐center prospective observational study investigated consecutive patients who underwent initial left atrial ablation for symptomatic paroxysmal (PAF) or persistent AF (persAF). Age groups (A–F) of less than 40, 40–49, 50–59, 60–69, 70–79 and more than or equal to 80 years were evaluated. Follow‐up (FU) included ECG, Holter monitoring and assessment of AF‐symptoms. From 2012 to 2016, a total of 786 patients (64 ± 11 years, range 21–85) underwent CBA. With advancing age, more cardiovascular comorbidities and larger LA diameter were observed, more females were included (each p < .001). PAF (57%) and persAF (43%, p = .320) were equally distributed over all age groups. Age was neither related to procedural parameters, nor to the complication rate (3.9%, p = .233). Median FU was 38 months. Two non‐procedure related noncardiac deaths occurred late during FU. Freedom from arrhythmia was independent of age at 18 months (p = .210) but decreased for patients more than or equal to 70 years at 24 months (p = .02). At 36 months, freedom from arrhythmia was 66%–74% (groups A–D), 54% (E) and 49% (F), respectively (p = .002). LA diameter and persAF were independent predictors, whereas age was a dependent predictor of recurrence. Conclusion CBA as the primary approach in the initial ablation procedure is safe and highly effective in the young, middle aged, and elderly population. LA diameter and persAF, but not ageing, were independent predictors for arrhythmia recurrence.

Do Elderly Patients with Atrial Fibrillation Have Comparable Ablation Outcomes Compared to Younger Ones? Evidence from Pooled Clinical Studies

“…A total of 27 studies with 113,106 AF patients (8686 elderly patients and 104,420 younger patients) were eligible, including 23 observational two-arm studies [ 6 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ] (8133 elderly AF patients and 104,420 younger AF patients) and four single-arm studies [ 32 , 33 , 34 , 35 ] (553 elderly AF patients). The selection flowchart is displayed in Figure 1 .…”

“…A total of 21 studies [ 6 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 29 , 30 , 31 ] on 18,608 AF patients in our meta-analysis reported rates of freedom from AF between elderly and younger groups. Compared with the younger group, the elderly group was significantly associated with a lower rate of freedom from AF (RR, 0.95; 95% CI, 0.92–0.99; p = 0.008; I 2 = 46.30%; Figure 2 ) via a random-effect model.…”

“…A total of 25 eligible studies (3879 elderly patients with AF) reported the rate of freedom from AF [ 6 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. The pooled rate of freedom from AF was 0.69 (95% CI, 0.63–0.75; p = 0.000; I 2 = 92.53%; Figure 5 ) with the random-effect model.…”

Cardiac computed tomography angiography‐derived analysis of left atrial appendage morphology and left atrial dimensions for the prediction of atrial fibrillation recurrence after pulmonary vein isolation

“…However, age was not an independent predictor for AF recurrence after CBA, which is in line with the recently published data. 24,25 Interestingly, LA volume was significantly smaller in females, while the LAA volume in females was similar to that in males.…”

Safety and Efficacy of Cryoballoon Ablation of Atrial Fibrillation in relation to the Patients’ Age: Results from a Large Real-World Multicenter Observational Project

“…Furthermore, in another study, no statistically significant differences in complication and recurrence rates were found by comparing a group of patients aged ≥75 with a group of patients aged <75 both treated with PVI by CBA for paroxysmal or persistent AF [ 42 ]. Other single-center or multicenter experiences provide further evidence for the safety and efficacy of CBA in elderly patients [ 43 – 47 ]. In summary, although positive and encouraging data on efficacy and safety in particularly old patients exist, they are limited and mainly based on small samples.…”