Pulmonary Vein Isolation in Elderly Patients ≥ 75 Years: A Propensity Score-Matched Analysis With Focus on Differences Among Atrial Fibrillation Types

Age is a major risk factor for development of atrial fibrillation (AF) and associated with increased recurrence rates in the setting of rhythm control. Current data tend to support catheter ablation in elderly patients, but uncertainties exist regarding efficacy and safety of ablation in elderly patients. This was a prospective single-centre observational study with propensity score matching (PSM) to investigate the influence of age on efficacy and safety of cryoballoon ablation (CBA) stratified by age (< 75 years vs ≥ 75 years) and AF phenotype (paroxysmal vs persistent). Primary efficacy endpoint was recurrence of atrial arrhythmia after a 90-day blanking period. Safety endpoints were death, stroke, or procedure-associated complications. Consecutive patients (n = 953) underwent CBA for first-time AF ablation. Median follow-up was 18 months. By means of PSM, 268 matches were formed. At 1 year, primary efficacy endpoint occurred in 22.4% of young vs 33.2% of elderly patients, including both AF phenotypes (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.47-0.90; P = 0.01). AF relapse occurred in 19.7% of young vs 28.5% of elderly patients with paroxysmal (HR, 0.63; 95% CI, 0.40-0.99; P = 0.046) compared with 25.9% (30 of 116, young) vs 38.8% (45 of 116, elderly) patients with persistent AF (HR, 0.62; 95% CI, 0.39-0.97; P = 0.038). No difference was observed regarding the incidence of safety endpoints between young and elderly patients (P = 0.38). CBA is associated with higher recurrence rates in elderly (≥ 75 years) than in younger patients, with highest recurrence rates in elderly patients with persistent AF. L'âge est un facteur de risque majeur pour le développement de la fibrillation auriculaire (FA) et est associé à des taux de récidive accrus dans le cadre du contrôle du rythme cardiaque. Les données actuelles tendent à encourager l'ablation par cathéter chez les patients âgés, mais des incertitudes subsistent quant à l'efficacité et à la sécurité de l'ablation chez les patients âgés. Il s'agissait d'une étude observationnelle prospective monocentrique avec appariement sur score de propension (ASP) visant à étudier l'influence de l'âge sur l'efficacité et la sécurité de l'ablation par cryoballon (ACB) stratifiée selon l'âge (< 75 ans vs ≥ 75 ans) et le phénotype de la FA (paroxystique vs persistante). Le critère principal d'efficacité était la récidive de l'arythmie auriculaire après une période de pause de 90 jours. Les critères d'évaluation