Cryoballoon Ablation in Older Patients With Heart Failure: Insights From a Large-Scale Multicenter Clinical Study
Hiroyuki Miyazawa1, Satoshi Yanagisawa2, Hirohiko Suzuki3
1Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan; Department of Cardiology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan.
Insights
Cryoballoon ablation (CBA) is a feasible treatment for older patients with atrial fibrillation (AF) and heart failure (HF), improving cardiac function. However, increased heart failure hospitalizations necessitate careful monitoring post-procedure.
Area of Science:
- Cardiology
- Electrophysiology
- Geriatrics
Background:
- Cryoballoon ablation (CBA) is effective for atrial fibrillation (AF).
- Feasibility of CBA in elderly patients with heart failure (HF) is not well-established.
Purpose of the Study:
- To evaluate the efficacy and prognosis of CBA in older patients (≥75 years) with HF.
- To compare outcomes between older and younger HF patients undergoing CBA.
Main Methods:
- Analysis of 549 HF patients (185 older, 364 younger) undergoing CBA.
- Comparison of recurrence, mortality, and HF hospitalization rates using survival analyses.
- Evaluation of changes in left ventricular ejection fraction (LVEF) and B-type natriuretic peptide levels.
Main Results:
- Procedural complication rates were similar between older and younger groups.
- Recurrence-free survival and mortality rates were comparable.
- Older patients had a higher HF hospitalization rate (4.0 vs 1.5 per 100 patient-years).
- LVEF and B-type natriuretic peptide levels improved in older patients post-ablation.
Conclusions:
- CBA is feasible for older AF patients with HF, improving cardiac parameters.
- Higher HF hospitalization rates in older patients warrant specific attention and monitoring.
- AF recurrence is linked to HF hospitalizations, particularly after one year.
Background:
Cryoballoon ablation (CBA) achieves satisfactory outcomes in patients with atrial fibrillation (AF). However, its feasibility in older patients with heart failure (HF) remains unclear.
Objectives:
This study examined the efficacy and prognosis of CBA in older patients with HF.
Methods:
Among 3,655 patients undergoing CBA at 17 institutions, 549 patients (185 with ≥75 years [older], and 364 with <75 years [younger]) diagnosed with HF were analyzed. Recurrence, mortality, and HF hospitalization after CBA between the older and younger groups were compared using Kaplan-Meier curves and Simon-Makuch analyses. Changes in left ventricular ejection fraction (LVEF) on echocardiography and B-type natriuretic peptide levels were evaluated using linear regression analysis. Major procedural complications included stroke, cardiac tamponade, phrenic nerve injury, prolonged hospitalization, and others.
Results:
Most (78%) patients had a preserved LVEF of ≥50%. Major procedural complications were similar in the older and younger groups (3.2% vs 4.7%; P = 0.670). The recurrence-free survival and mortality rates were comparable between the 2 groups during a median follow-up period of 21.5 (12.0-37.0) months. The HF hospitalization rate was higher in the older group (4.0 vs 1.5 per 100 patient-years; P = 0.008). In the older group, LVEF and B-type natriuretic peptide levels improved after ablation (from 57.4% to 60.0%, and 173 [113-292] to 87.8 [42-218] pg/mL). AF recurrence and HF hospitalization were closely linked, with most hospitalizations occurring after a year postablation.
Conclusions:
CBA for AF in older patients with HF is feasible and improves cardiac parameters; however, specific care is required owing to this population's unique characteristics.
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