[Catheter ablation of ventricular extrasystoles and ventricular tachycardia in the elderly]
Philipp Halbfaß1,2, Karin Nentwich1, Kai Sonne1
1Klinik für Interventionelle Rhythmologie, Herz- und Gefäßklinik GmbH Bad Neustadt, Salzburger Leite 1, 97616, Bad Neustadt a. d. Saale, Deutschland.
Insights
Catheter ablation is effective for ventricular tachycardia (VT) in older adults, but carries a higher complication risk. Careful patient selection and specialized centers are crucial for optimizing outcomes in elderly patients undergoing VT ablation.
Area of Science:
- Cardiology
- Electrophysiology
- Geriatric Medicine
Background:
- Structural heart disease prevalence increases with age, leading to ventricular arrhythmias (VT).
- Catheter ablation is a safe and effective therapy for recurrent VT, but data in patients over 75 is limited.
- Older patients have unique comorbidities that may affect VT ablation outcomes compared to younger cohorts.
Purpose of the Study:
- To evaluate the efficacy and safety of catheter ablation for ventricular tachycardia in patients aged 75 years and older.
- To compare outcomes of VT ablation in elderly patients with those in younger populations.
- To identify specific challenges and considerations for VT ablation in the geriatric population.
Main Methods:
- Review of studies including patients aged 75 years and older undergoing catheter ablation for VT.
- Analysis of efficacy, complication rates (especially groin complications), and safety profiles.
- Inclusion of data on both endocardial and epicardial ablation approaches in older adults.
Main Results:
- Catheter ablation demonstrates comparable efficacy for VT in patients ≥75 years old.
- A higher complication rate, primarily groin complications, is observed in older patients.
- Ischemic VT ablation is effective and safe in ≥75 year olds; data for other structural heart diseases are limited.
- Epicardial procedures are also feasible and safe in patients ≥80 years old.
Conclusions:
- The primary goals of VT ablation in older patients are to improve quality of life and reduce morbidity.
- Long-term survival is generally lower in older patients due to their age and comorbidities.
- Careful assessment of risks, benefits, and alternative therapies is essential for individualizing VT ablation treatment in elderly patients.
Background:
The prevalence of structural heart disease increases with higher age, and thereby the basis for ventricular arrhythmias is created. Catheter ablation has been shown to be an effective therapy option that is very safe and achieves good long-term results in patients with recurrent ventricular tachycardia (VT). Data regarding ablation in patients older than 75 years is sparse, although this patient group was included as a minority in most published VT ablation studies. Data from younger patient collectives may not be transferable to older patient cohorts due to differences in patient comorbidities and baseline characteristics.
Methods:
Studies with patient collectives ≥75 years or even ≥80 years show comparable efficacy of catheter ablation for VT; however, the complication rate is higher, mainly due to groin complications, increases. Catheter ablation of ischemic VT appears effective and safe even in ≥75 year olds; however, extensive data for other structural heart diseases are lacking. Epicardial procedures are also possible and safe in older patients (≥80 years). Due to the significant challenges of VT ablation in older patients, including the consideration of complex comorbidities, these should be performed in specialized centers with high expertise.
Conclusion:
The aim of catheter ablation in older patients is, above all, to improve quality of life and morbidity. Long-term survival is significantly lower due to the "near end of life" situation than in younger patients. Careful consideration of alternative therapy options, chances for success of the catheter ablation, and their risks, taking into account specific patient conditions and symptoms, is crucial in these patients.
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