Background: Atrial fibrillation (AF) is the most frequent sustained cardiac arrhythmia in adults with a current estimated prevalence between 2-4% in the general population. AF prevalence increases with advancing age and it is estimated that nearly 10% of octogenarians may be affected by this arrhythmia. In terms of safety and efficacy, Cryoballoon ablation (CB-A) has become a valid option for achieving pulmonary vein isolation (PVI) in patients affected by symptomatic atrial fibrillation (AF). However, CB-A data in octogenarians are still scarce and limited to single-centre experiences. The present multicenter study aimed to compare the outcomes and complications of index CB-A in patients older than 80 years old with a cohort of younger patients.
Methods and results: We retrospectively enrolled 97 consecutive patients aged ≥ 80 years who underwent PVI using the second-generation CB-A. This group was compared with a younger cohort of patients using a 1:1 Propensity score matching. After the matching, 70 patients from the elderly group were analyzed and compared with 70 younger patients (control group). The mean age was 81.4 ± 1.9 years among octogenarians and 65.2 ± 10.2 years in the younger cohort. The global success rate after a median follow-up of 23 [18 – 32.5] months was 60.0% in the elderly group and 71.4% in the control group (p = 0.17). Phrenic nerve palsy (PNP) was the most common complication occurring in a total of 11 patients (7.9%): in 6 (8.6%) patients for the elderly group and in 5 patients (7.1%) of the younger group (p = 0.51). Only 2 (1.4 %) major complications occurred: 1 (1.4%) femoral artery pseudoaneurysm in the control group, which resolved with a tight groin bandage and 1 (1.4%) case of urosepsis in the elderly group. Arrhythmia recurrence during the blanking period (BP) and the need for electrical cardioversion (ECV) to restore sinus rhythm after PVI were found to be the only independent predictors of late arrhythmia relapses.
Conclusions: The present study showed that CB-A PVI is as feasible, safe and effective among octogenarians as it is in younger patients.