Safety and Outcomes of Catheter Ablation for Consecutive Atrial Tachycardia in Elderly Patients After Previous Cardiac Interventions

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.

Keywords: atrial fibrillation; atrial tachycardia; catheter ablation; elderly patients; electroanatomical mapping.

Figure 1

Elderly patients present with more cardiac comorbidities. Patients ≥75 years present more frequently with arterial hypertension, coronary artery disease, valvular disease, and with an implanted pacemaker compared to patients <75 years. aHTN = arterial hypertension; CAD = coronary artery disease. **** p < 0.0001; *** p < 0.001; * p < 0.05.

Figure 2

Procedural data, acute success, and major complications do not differ significantly between elderly and younger patients. (A) Procedural data and (B) acute procedural success and major complications do not differ significantly between patients ≥75 and <75 years. ns = not significant; RF = radiofrequency.

Figure 3

Repeat ablation is less frequently performed in elderly patients. Cumulative event-free survival probability curve illustrates freedom from (A) arrhythmia recurrence and (B) repeat ablation in patients ≥75 vs. <75 years. AF = atrial fibrillation; AT = atrial tachycardia. p values are based on the log-rank test.