Cryoballoon ablation of atrial fibrillation in octogenarians: one year outcomes from the cryo global registry

Abstract

Background: Limited information is available on the safety and efficacy of cryoballoon ablation (CBA) in elderly patients with atrial fibrillation (AF). Moreover, global utilization of CBA in this population (≥ 80 years old) has not been reported. This study's objectives were to determine the use, efficacy, and safety of CBA to treat octogenarians suffering from AF.

Methods: In this sub-analysis of the Cryo Global Registry, 12-month outcomes of treating AF via CBA in octogenarians were compared to patients < 80 years old. Efficacy was evaluated as time to a ≥ 30 s atrial arrhythmia (AA) recurrence. Healthcare utilization was determined via repeat ablations and hospitalizations. Improvement upon disease burden was evaluated through patient reporting of symptoms and the EQ-5D-3L quality of life (QoL) survey.

Results: The octogenarian cohort (n = 101) had a higher prevalence of females (51.5% vs 35.7%) and CHA₂DS₂-VASc scores (4.2 ± 1.3 vs 2.0 ± 1.5) compared to the control cohort (n = 1573, both p < 0.01). Even when adjusting for baseline characteristics and antiarrhythmic drug usage, freedom from AA recurrence at 12 months (80.6% vs 78.9%, HR_adj:0.97 [95% CI:0.59-1.58], p = 0.90) was comparable between octogenarians and control, respectively. Similar serious adverse event rates were observed between octogenarians (5.0%) and control (3.2%, p = 0.38). The groups did not differ in healthcare utilization nor reduction of AF-related symptoms from baseline to follow-up, but both experienced an improvement in QoL at 12 months.

Conclusions: Despite more age-related comorbidities, CBA is a safe and effective treatment for AF in octogenarians, with efficacy and adverse events rates akin to ablations performed in younger patients.

Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT02752737.

Keywords: Atrial fibrillation; Catheter ablation; Cryoballoon; Octogenarians; Registry.

Fig. 1

Rhythm Monitoring during 12-Month Follow-up. Percentage of patients monitored for atrial arrhythmia recurrences with none (blue), one (gray), two (aqua) or three or more (black) 12-lead ECGs or Holter monitoring events over the 12-month follow-up period. Proportion of patients with continuous monitoring (pacemaker/implantable cardiac monitor) are shown in dark gray

Fig. 2

Freedom from Atrial Arrhythmia Recurrence at 12 Months. Kaplan–Meier estimate of freedom from ≥ 30 s recurrences of AF/AFL/AT at 12 months after a 90-day blanking period in octogenarians (red line) or controls (blue line) treated with CBA. Hazard ratios are presented from unadjusted (HR_unadj) and adjusted (HR_adj) Cox regression models, where the adjusted model include all subject characteristics from Table 1 with the exception of CHA₂DS₂-VASc score and age

Fig. 3

Freedom from Repeat Ablations, Hospitalization, and Antiarrhythmic Drug Usage. Kaplan–Meier estimate of (A) freedom from repeat ablation at 12 months, (B) freedom from all-cause hospitalization at 12 months, and (C) freedom from CV-related hospitalization at 12 months in octogenarians (red lines) or controls (blue lines) treated with CBA. Hazard ratios are presented from unadjusted (HR_unadj) and adjusted (HR_adj) Cox regression models, where the adjusted model include all subject characteristics from Table 1 with the exception of CHA₂DS₂-VASc score and age. (D) AAD prescription in octogenarians and controls at discharge (blue) and at 12 months (gray)

Fig. 4

Atrial Fibrillation-Related Symptoms. Distribution of AF-related symptoms in octogenarians at baseline (blue) and 12 months (gray) and in controls at baseline (turquoise) and 12 months (black). A total of 1512/1674 patients reported symptoms