Catheter ablation (CA) for atrial fibrillation and atrial tachycardia in the elderly: Results from a large single center study in 293 patients over 80 years old
Authors: Tunsch Martinez A , Bahlke F , Englert F , Erhard N , Krafft H , Risse E , Telishevska M , Lengauer S , Lennerz C , Reents T , Bourier F , Hessling G , Deisenhofer I 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The increasing incidence of atrial arrhythmias in the elderly is mostly adjudicated to the age-dependent development of arhythmic substrate. In recent years, CA has become a standard approach in treating atrial fibrillation (AF) and left and right atrial flutter (AFlut). Data regarding safety and efficacy of CA in patients over 80 years old remains scarce. This study aims to report on our high-volume center experience regarding the safety and efficacy of CA in a large cohort of patients &gt;80 years of age.

Methods
All patients &gt;80 years undergoing de-novo-CA for AF or AFlut (parox. AF n=85, 29%; pers. AF n=146, 49.8%; left-/right- AFlut n=62, 21.2%) in our institution between 01/2016 and 12/2020 were included (n=293; mean age 82.3 ± 2.27 years). For safety analysis, all complications requiring intervention or causing sequels occurring during or up to 30 days after CA were collected. For efficacy, AF/Aflut-free survival was analysed after a blanking period (3 months) using 7-day Holter ECGs.

Results
Baseline characteristics are shown in table 1. Most patients suffered from multiple cardiovascular co-morbidities (CHA2DS2-VASc-score 4.45 ± 1.15), &gt;30% were on reduced OAC. Isolation of all pulmonary veins (PV) and/or termination of AFlut with demonstration of bidirectional block across the ablation line was achieved in all patients (procedure success 100%).
During a follow-up of 400 ± 446 days, 61.4% of patients remained in stable sinus rhythm after 1.56 ± 0.81 ablations (Figure 1). Single procedure outcome was significantly higher in paroxysmal AF compared to persistent AF (p = 0.03, s. Figure 1b). 32 patients (10.9%) were lost to follow-up.
In 17 patients (5.8%) complications occurred: 1 case of pericardial tamponade during PVI and CA of PVCs (LA and CS). 2 patients suffered a stroke within a week after CA of persistent AF and left AFlut, 1 TIA occurred after CA of persistent AF. All patients had been under uninterrupted full-dose OAC. Major groin complications occurred in 13 patients (4.4%). 3 arterial bleeds treated by covered stent implant, 7 pseudoaneurysms needing thrombin injections, 2 infections of the puncture site and 1 patient requiring surgical treatment for a large hematoma.
9 patients underwent pacemaker implantation shortly after CA due to underlying symptomatic sick-sinus-syndrome or higher degree AV-blocks demasked in sinus rhythm, none were procedure-related.

Conclusion
De novo catheter ablation of AF and AFlut in very old patients is safe and effective. In paroxysmal AF, ablation success rates seem to be similar to those in younger patients and are significantly higher than for persistent AF. After 1.56 ablation procedures, &gt;60% of patients were free of arrhythmia, suggesting that the supposed atrial remodelling does not preclude an interventional treatment approach.