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Safety and Outcomes of Catheter Ablation for Consecutive Atrial Tachycardia in Elderly Patients After Previous
Ann-Kathrin Kahle1,2, Fares-Alexander Alken1, Katharina Scherschel1,3,4
1Division of Cardiology, Angiology, Intensive Care Medicine, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Kirchfeldstrasse 40, 40217 Düsseldorf, Germany.
Insights
Atrial tachycardia ablation is safe and effective in patients aged 75 and older, even after prior cardiac interventions. Age alone should not preclude consideration for this procedure in elderly individuals.
Area of Science:
- Cardiology
- Electrophysiology
- Geriatric Medicine
Background:
- Age is a significant risk factor for atrial arrhythmias and adverse cardiovascular outcomes.
- The incidence of atrial tachycardia (AT) increases with age, yet data on elderly patients undergoing AT ablation are scarce.
- Previous cardiac interventions are common in patients requiring AT ablation.
Purpose of the Study:
- To evaluate the safety and efficacy of atrial tachycardia (AT) ablation in patients aged 75 years and older compared to younger patients (<75 years).
- To assess acute and mid-term outcomes, including success rates, complications, and recurrence rates.
- To determine if age alone is a contraindication for AT ablation in the elderly.
Main Methods:
- A retrospective analysis of 420 consecutive patients undergoing AT ablation following prior cardiac interventions.
- Comparison of safety and outcomes between 140 patients aged ≥75 years and 280 patients aged <75 years.
- Data collected included patient demographics, comorbidities, procedural success, complication rates, hospital stay, and mid-term follow-up for recurrence.
Main Results:
- Patients ≥75 years had a higher prevalence of female sex and cardiac comorbidities like hypertension and coronary artery disease.
- Acute success rates (96.4% vs. 97.9%) and major complication rates (1.4% vs. 0.7%) were similar between the elderly and younger groups.
- Mid-term arrhythmia recurrence rates were comparable (45.0% vs. 49.3%), but repeat ablation was less frequent in the ≥75 years group (25.7% vs. 36.1%).
Conclusions:
- Atrial tachycardia ablation is a safe and effective procedure for patients aged 75 and older, particularly in specialized centers.
- Age should not be a sole limiting factor for considering AT ablation; patient-specific factors are crucial.
- The decision for AT ablation in elderly patients should be individualized based on arrhythmia burden, symptom severity, and clinical/procedural risks.
Abstract:
Background: Age is a relevant risk factor for the development of atrial arrhythmias and an independent predictor of adverse cardiovascular outcomes. The incidence of atrial tachycardia (AT) is known to increase with aging, but so far, there are no data on elderly patients with AT. Therefore, we sought to assess the safety and outcomes of AT ablation in patients ≥75 years compared to those <75 years. Methods: A total of 420 consecutive patients undergoing AT ablation after previous cardiac interventions (mean 2.1 ± 0.1 prior ablation procedures) were analyzed. Safety, as well as acute and mid-term outcomes of AT ablation were compared between 140 patients ≥75 years (mean age 78.1 ± 0.2 years, 22.9% aged ≥80 years (range 80-86 years)) and 280 patients <75 years (mean age 62.2 ± 0.6 years). Results: Patients ≥75 years were more often female (54.3% vs. 38.2%; p = 0.0024) and presented with more cardiac comorbidities, including arterial hypertension (85.0% vs. 64.3%; p < 0.0001) and coronary artery disease (33.6% vs. 18.2%; p = 0.0006). Acute success of AT ablation was reached in 96.4% vs. 97.9% of patients (p = 0.5173). Major complications (1.4% vs. 0.7%; p = 0.6035) and duration of hospital stay (2 (IQR 2-4) days vs. 2 (IQR 2-3) days; p = 0.9125) did not differ significantly between groups. During a follow-up of 364 (IQR 183-729.5) days, arrhythmia recurrences occurred in 45.0% vs. 49.3% (p = 0.4684), whereas repeat ablation was less frequently performed in patients ≥75 years (25.7% vs. 36.1%; p = 0.0361). Conclusions: AT ablation in patients ≥75 years after previous cardiac interventions in tertiary arrhythmia centers is safe and effective. Therefore, AT ablation should not be ruled out in elderly patients due to age alone, but should be considered based on arrhythmia burden, symptom severity and concomitant clinical and procedural risk factors.
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