Clinical efficacy and safety of radiofrequency catheter ablation for atrial fibrillation in patients aged ≥80 years

Safety and efficacy of pulsed-field ablation for atrial fibrillation in the elderly: A EU-PORIA sub-analysis

BACKGROUND

The role of catheter ablation in elderly patients with atrial fibrillation (AF) is unclear. Pulsed field ablation (PFA) demonstrates a favorable clinical profile, however, data on elderly patients are lacking.

AIMS

We aimed to assess the safety and efficacy of PFA in the elderly, using data from the EU-PORIA registry.

METHODS

Periprocedural complications and long-term safety and efficacy outcomes of AF ablation using the pentaspline PFA catheter (Farapulse™) were compared between patients older than 80 years old and their younger counterparts, across seven European centers.

RESULTS

Among the 1233 patients in the registry, 88 (7.1 %) were older than 80 years. Elderly patients were more often females (51.1 % vs 37.8 %, p = 0.01) with a lower median BMI (26.0, IQR:23.5-29.2 vs 26.9, IQR:24.4-30.4 kg/m2, p = 0.02), a higher median CHA2DS2-VASc score (4, IQR:3-5 vs 2, IQR:1-3, p < 0.001) and a higher incidence of hypertension (73.9 % vs 52.7 %, p < 0.001). In both groups, most patients had paroxysmal AF (58.0 % vs 60.3 %, p = 0.65). Ablation in the elderly was more frequently performed with minimally interrupted anticoagulation (87.5 % vs 59.7 %, p < 0.001). Despite comparable rates of overall complications (5.7 % vs 3.5 %, p = 0.29), elderly patients had a higher incidence of stroke (2.3 % vs 0.3 %, p = 0.04). At 12 months, major adverse clinical events (4.5 % vs. 2.1 %, p = 0.12) and arrhythmia-free survival (70 % vs 74 %, p = 0.69) were comparable in both groups. None of the recurrence-free elderly patients were on antiarrhythmic drugs at the end of follow-up.

CONCLUSION

In this real-world cohort, the efficacy of PFA for AF was similar in elderly and younger patients. Despite comparable complication rates, a higher incidence of stroke was observed in the elderly.

Safety and efficacy of ablation for atrial fibrillation in combination with left atrial appendage occlusion in octogenarians

BACKGROUND

Catheter ablation (CA) combined with left atrial appendage occlusion (LAAO) is a feasible approach for atrial fibrillation (AF) patients. Its role in octogenarians with AF is unclear.

HYPOTHESIS

In AF patients over 80 years, CA combined with LAAO is a feasible way in restoring sinus rhythm and preventing stroke.

METHODS

This is a single-center retrospective study. Patients who underwent CA and LAAO in a single procedure between March 2018 and December 2020 were included. Efficacy endpoints included procedural success rate, AF recurrence rate, and thromboembolic events. Safety endpoints included pericardial effusion/cardiac tamponade, device-related thrombus (DRT), all-cause death, and major bleeding.

RESULTS

Five hundred and five patients (mean age 69.5 ± 7.7 years; 230 [45.5%] female) were included, with 46 (9.1%) patients aged ≥80 years old (octogenarian group). Prevalence of paroxysmal AF (25 [54.3%] vs. 207 [45.1%], p < 0.001) and CHA2DS2VASc score (4.1 ± 1.3 vs. 3.1 ± 1.4, p < 0.0001) were higher in octogenarian patients. There were six cases (1.2%) of pericardial effusion (all in nonoctogenarian patients). At 3 months postprocedure, 437 patients underwent TEE/CT. Thirty-two (80%) octogenarian patients and 308 (77.6%) nonoctogenarian patients had no peri-device leak. After a mean follow-up of 26.9 ± 9.1 months, AF was documented in 10 (21.7%) patients in octogenarian group and in 103 (22.4%) patients in nonoctogenarian group (p = 0.99). The annual thromboembolic risk was 2.1% and 0.8% in the octogenarian group and nonoctogenarian group, respectively. Death occurred in 16 nonoctogenarian patients. One major bleeding was recorded in the octogenarian group.

CONCLUSIONS

The combination of CA and LAAO in a single procedure is a feasible treatment option in octogenarians with comparable efficacy and safety profile.

The Characteristics of Fear of Recurrence and the Effect of Cognitive-Behavioral Stress Management Intervention in Patients after Radiofrequency Ablation of Atrial Fibrillation

The aim of this study was to grasp the current situation of fear of recurrence in patients after radiofrequency ablation of atrial fibrillation and to explore the application effect of cognitive-behavioral stress management in patients with fear of recurrence after radiofrequency ablation of atrial fibrillation. From July 2020 to July 2021, 150 patients with fear of recurrence of atrial fibrillation after radiofrequency ablation in our hospital were divided into a control group and an intervention group, with 75 cases in each group. Both groups received conventional nursing methods, and the intervention group received 8 weeks of cognitive-behavioral stress management. Before the intervention and after the intervention, the general situation questionnaire, the Chinese version of the Fear Disease Progression Simplified Scale (FoP-Q-SF), the Perceived Stress Scale (CPSS), and the Positive Psychological Capital Questionnaire (PPQ) were used for evaluation. Before the intervention, there were no significant differences in general data, degree of fear of recurrence, stress perception, and psychological capital scores between the two groups (P > 0.05). After 8 weeks of cognitive-behavioral stress management intervention, the fear recurrence, the total score of stress perception, and the scores of each dimension in the intervention group were significantly lower than those in the control group, and the psychological capital score was significantly higher than that in the control group, with statistically significant differences (P < 0.05). Cognitive-behavioral stress management method can significantly reduce the fear of recurrence and stress level of patients after radiofrequency ablation of atrial fibrillation, and improve their psychological capital level.

Do Elderly Patients with Atrial Fibrillation Have Comparable Ablation Outcomes Compared to Younger Ones? Evidence from Pooled Clinical Studies

Background: Age is an independent risk factor of the progress and prognosis of atrial fibrillation (AF). However, ablation outcomes between elderly and younger patients with AF remain elusive. Methods: Cochrane Library, Embase, PubMed, and Web of Science were systematically searched up to 1 April 2022. Studies comparing AF ablation outcomes between elderly and younger patients and comprising outcomes of AF ablation for elderly patients were included. Trial sequential analysis (TSA) was performed to adjust for random error and lower statistical power in our meta-analysis. Subgroup analysis identified possible determinants of outcome impact for elderly patients after ablation. Moreover, linear and quadratic prediction fit plots with confidence intervals were performed, as appropriate. Results: A total of 27 studies with 113,106 AF patients were eligible. Compared with the younger group, the elderly group was significantly associated with a lower rate of freedom from AF (risk ratio [RR], 0.95; p = 0.008), as well as a higher incidence of safety outcomes (cerebrovascular events: RR, 1.64; p = 0.000; serious hemorrhage complications: RR, 1.50; p = 0.035; all-cause death: RR, 2.61; p = 0.003). Subgroup analysis and quadratic prediction fit analysis revealed the follow-up time was the potential determinant of freedom from AF for elderly patients after AF ablation. Conclusions: Our meta-analysis suggests that elderly patients may have inferior efficacy and safety outcomes to younger patients with AF ablation. Moreover, the follow-up time may be a potential determinant of outcome impact on freedom from AF for elderly patients after AF ablation.

Catheter ablation for atrial fibrillation in elderly patients: Systematic review and a meta-analysis

AIMS

Catheter ablation (CA) is established therapy for patients with atrial fibrillation (AF); however, there is a limited understanding of CA in elderly patients. We studied the long-term efficacy and periprocedural safety of radiofrequency and cryoballoon CA for elderly patients with AF.

METHODS

PubMed and Embase were searched through April 2021 to investigate the comparative outcomes between elderly and non-elderly patients who underwent CA for AF. The primary efficacy and safety endpoints were AF recurrence and procedure-related complications, respectively. Subgroup analyses were performed by procedure type of CA.

RESULTS

The search identified 20 observational studies with 110,606 patients, including 8009 elderly patients (7.2%). The risk of AF recurrence was not significantly different between elderly and non-elderly patients (hazard ratio, 1.37; 95% confidence interval [CI], 0.94-2.00; p = .10, I²  = 70%). However, relative to the non-elderly, elderly patients had significantly higher major complications (risk ratio [RR], 1.32; 95% CI, 1.14-1.54], p < .01, I²  = 0%) and overall complications (RR, 1.26; 95% CI, 1.00-1.57; p = .05, I²  = 56%) with higher cerebrovascular events (RR, 1.68; 95% CI, 1.25-2.25; p = < .01, I²  = 0%). Subgroup analysis with cryoballoon CA showed that procedure-related complications in elderly patients were similar to those in non-elderly patients but not with radiofrequency CA.

CONCLUSIONS

CA for AF in elderly patients has comparable long-term efficacy compared to that in non-elderly patients; however, the incidence of procedure-related complications were higher in elderly patients. Cryoballoon CA did not confer a higher procedure-related risk in elderly patients.