Pulmonary vein isolation in elderly patients ≥ 75 years: a propensity-score matched analysis with focus on differences between atrial fibrillation types.

BACKGROUND: Age is a major risk factor for development of atrial fibrillation (AF) and associated with increased recurrence rates in the setting of rhythm control. Current data tend to support catheter ablation in elderly patients but uncertainties exist regarding efficacy and safety of ablation in elderly patients.

METHODS: Prospective, single-center observational study with propensity score matching (PSM) to investigate the influence of age on efficacy and safety of cryoballoon ablation (CBA) stratified by age (<75yrs versus ≥75yrs) and AF phenotype (paroxysmal versus persistent). Primary efficacy endpoint was recurrence of atrial arrhythmia after 90-day blanking period. Safety endpoints were death, stroke or procedure-associated complications.

RESULTS: Consecutive patients (n=953) underwent CBA for first time AF ablation. Median follow-up was 18 months. By means of PSM, 268 matches were formed. At 1 year, primary efficacy endpoint occurred in 22.4% of young versus (vs.) 33.2% of elderly patients including both AF phenotypes (hazard ratio [HR] 0.65; 95% confidence interval [CI], 0.47-0.90; P=0.01). AF relapse occurred in 19.7% of young vs. 28.5% of elderly patients with paroxysmal (HR 0.63; 95%CI, 0.40-0.99; P=0.046) compared with 25.9% (30/116, young) vs. 38.8% (45/116, elderly) patients with persistent AF (HR 0.62; 95%CI, 0.39-0.97; P=0.038). No difference was observed regarding the incidence of safety endpoints between young and elderly patients (P=0.38).

CONCLUSION: CBA is associated with higher recurrence rates in elderly (≥75yrs) than in younger patients, with highest recurrence rates in elderly patients with persistent AF.