Long-Term Clinical Efficacy and Risk of Catheter Ablation for Atrial Fibrillation in Octogenarians

Bunch, T. Jared; Weiss, J. Peter; Crandall, Brian G.; May, Heidi T.; Bair, Tami L; Osborn, Jeffrey S.; Anderson, Jeffrey L.; Lappé, Donald; Muhlestein, Joseph B.; Nelson, R N Jennifer; Day, John D.

doi:10.1111/j.1540-8159.2009.02604.x

Cited by 112 publications

(123 citation statements)

References 35 publications

(67 reference statements)

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“…167,455 Numerous studies have evaluated ablation outcomes in ageing patients (variously defined as .65 through to .80). 444,445,[456][457][458][459][460][461][462] Observational studies have consistently reported high multiple procedure success rates at 12 months of up to 80% in older patients. Conflicting data exist regarding outcomes in comparative studies with one study demonstrating a reduced success rate in patients over 65 years while another study showed similar efficacy in patients over the age of 80 years to the younger cohort.…”

Section: Age and Atrial Fibrillation Ablationmentioning

confidence: 99%

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

et al. 2016

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Section: Age and Atrial Fibrillation Ablationmentioning

confidence: 99%

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

et al. 2016

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“…Patients over age 80 years in the paper of Tan et al 15 were less likely to undergo a repeat procedure than younger patients, but again the success and complication rates were not significantly different in the age group over 80 years than in those 60-69 years (70% versus 74% for success rate). Another study by Bunch et al 16 found also no increased risk of periprocedural complications in 35 patients aged 80 years and older.…”

Section: Discussionmentioning

confidence: 99%

Ablation of atrial fibrillation after the retirement age: considerations on safety and outcome

Haegeli

Duru

Lockwood

et al. 2010

J Interv Card Electrophysiol

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BACKGROUND: Although the incidence of atrial fibrillation (AF) progressively increases with age, the vast majority of AF ablation is done in middle-aged patients. We evaluated the feasibility and safety of catheter ablation in patients older than 65 years of age with paroxysmal and persistent AF. METHODS: Out of a total of 230 consecutive AF ablation procedures, 45 patients were older than 65 years of age and underwent 53 procedures. The ablation strategy consisted of wide-area circumferential lines around both ipsilateral pulmonary veins using a three-dimensional mapping system. RESULTS: The mean age was 69 ± 3.5 years (35 males). The mean duration for AF was 8.7 ± 6.5 years. Thirty-nine had paroxysmal and six persistent AF despite use of 1.38 ± 0.77 antiarrhythmic drugs. All patients had a structurally normal heart. Eleven had systemic hypertension. Mean procedure time was 187 ± 33 min. Acute procedural success rate with abolition of all pulmonary vein potentials was achieved in all patients. Pericardial tamponade requiring percutaneous drainage occurred in one (1.9%) patient. There were no cardioembolic events. Among the 43 patients whose clinical outcome was assessed at 6 months, 34 (79%) had a significant reduction (>90%) of the total symptomatic AF burden, compared to pre-ablation, with a complete lack of symptomatic AF in 32 (74%) patients. The success rate was higher for patients with paroxysmal versus persistent AF (81 vs. 67%). Six patients (11%) underwent repeat procedures. CONCLUSIONS: Catheter ablation is a safe and effective treatment for patients over the age of 65 years with symptomatic, drug-refractory AF. Therefore, patients should not be excluded from undergoing AF catheter ablation on the basis of age alone.

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“…In the present study, procedurerelated complications developed in 2 of 28 patients of the urgent group (7%) and 2 of 36 patients of the elective group (6%). The rates of complications related to contemporary ablation procedures in the patients 80 years or older were reported to be up to 4% for the RFCA of various arrhythmias 13 , up to 9% for that of AF 14,15,17 , and up to 14% for that of VT 16 . Studies …”

Section: Complications Related To Catheter Ablationmentioning

confidence: 99%

“…Recently, the results of AF ablation (isolation of all pulmonary veins with or without additional lesions), which requires a more complicated process to be completed, have been reported. In observational studies 14,15 comparing the procedural results between patients 80 years or older and younger patients, the arrhythmia-free rates without AADs in the late follow-up period were 69% and 71%, respectively, in 1 study 14 and 78% and 75%, respectively, in the other study 15 . Regarding VT ablation in patients 80 years or older, the results in 14 patients (mean age, 84 years) with ischemic or nonischemic cardiomyopathy has recently been published 16 .…”

Section: Catheter Ablation In Very Elderly Personsmentioning

confidence: 99%

Urgent Catheter Ablation in Octogenarians with Serious Tachyarrhythmias

et al. 2016

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Background: Urgent catheter ablation is often required for various tachyarrhythmias; however, its efficacy and safety in elderly patients have not been fully elucidated.Methods: This study included consecutive octogenarians who underwent urgent radiofrequency catheter ablation (RFCA) for various serious tachyarrhythmias (urgent group, n=28) that were lifethreatening, hemodynamically deleterious, or provoking ischemia, and consecutive octogenarians who underwent elective RFCA (control group, n=36). The rate of a successful RFCA, complications, later arrhythmia recurrences, and mortality were compared between the groups.Results: There was no significant difference in the breakdown of the targeted arrhythmias between the groups, and common-type atrial flutter was most often targeted in both the urgent group (57%) and the elective group (56%). Compared with the control group patients, the patients of the urgent group were older (84 3 vs. 82 2 years P=0.001), with a higher frequency of baseline heart disease (68% vs. 17%, P <0.001) and lower left ventricular ejection fraction (45% 15% vs. 68% 10%, P<0.001). The rates of acute success (100% vs. 100%, P=1.00) and later arrhythmia recurrences (4% vs. 14%, P=0.22) were comparable between the groups. Two patients in the urgent group and 2 in the elective group had procedure-related nonlethal complications (7% vs. 6%, P=1.00): groin hematoma in 2, pressure ulcer in 1, and CO2 narcosis in 1. There were no in-hospital deaths, and mortality during follow-up did not differ between the urgent and elective groups (6.0% vs. 3.9% per year, log-rank P=0.38). Conclusion:Even in octogenarian patients, urgent catheter ablation for serious tachyarrhythmias can be safely performed with a high success rate and acceptable prognosis. (J Nippon Med Sch 2016; 83: 62 70)

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Long-Term Clinical Efficacy and Risk of Catheter Ablation for Atrial Fibrillation in Octogenarians

Cited by 112 publications

References 35 publications

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

Ablation of atrial fibrillation after the retirement age: considerations on safety and outcome

Urgent Catheter Ablation in Octogenarians with Serious Tachyarrhythmias

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