Persistent Atrial Fibrillation in Elderly Patients: Limited Efficacy of Pulmonary Vein Isolation

Abstract

(1) Background: Cryoballoon pulmonary vein isolation (cryoPVI) is established for symptomatic paroxysmal atrial fibrillation (AF) treatment, but its value in persistent AF is less clear. In particular, limited data are available on its efficacy in elderly patients (≥75 years) with persistent AF. Age is an important modifier of AF progression and represents a risk-factor for AF recurrence. (2) Methods: Prospective, single-center observational study to evaluate the impact of age on efficacy and safety of cryoPVI in elderly patients. Primary efficacy endpoint was symptomatic AF recurrence after 90-day blanking period. Primary safety endpoints were death from any cause, procedure-associated complications or stroke/transient ischemic attack. Median follow-up was 17 months (range 3–24). (3) Results: We included 268 patients with persistent AF (94 ≥ 75 years of age). Multivariate Cox regression analysis identified age as the only independent factor influencing AF recurrence in the overall cohort (p = 0.006). To minimize confounding bias in efficacy and safety analysis of cryoPVI, we matched younger and elderly patients with respect to baseline characteristics. At 24 months, primary efficacy endpoint occurred in 13/69 patients <75 years and 31/69 patients ≥75 years of age (24 months Kaplan–Meier event-rate estimates, HR 0.34; 95% CI, 0.19 to 0.62; log-rank p = 0.0004). No differences were observed in the occurrence of safety end points. (4) Conclusions: Elderly (≥75 years) patients with persistent AF undergoing cryoPVI had an approximately threefold higher risk of symptomatic AF recurrence than matched younger patients. Accordingly, other treatment modalities may be evaluated in this population.

Cryoballoon pulmonary vein isolation for atrial fibrillation in obese patients: A non-inferiority analysis

“…Nevertheless, age correlates with the incidence of AF [41] and is independently associated with an increased recurrence rate after pulmonary vein isolation in persistent AF. [42] Whereas in univariate analysis BMI as a continuous variable showed a trend toward an inverse correlation with recurrence of AF after CBA, after adjustment for age, sex, and type of AF, BMI showed no relevant effect on treatment outcome, underscoring the findings of this noninferiority trial.…”

Vorhofflimmern im Alter – die geriatrische Perspektive

“…Der Effekt ist unabhängig vom Alter, Ge-schlecht oder einer bestehenden Herzinsuffizienz [8]. Allerdings konnte auch gezeigt werden, dass die positiven Effekte bei Patienten über 75 Jahre abnehmen könnten [13]. Neben den kardiologischen Parametern finden sich auch Hinweise, dass eine Ablation gegenüber einer medikamentösen Therapie zu einer signifikanten psychologischen Entlastung bei den Betroffenen führt [14].…”