Abstract 16712: Safety & Efficacy of Cryoballoon versus Radiofrequency Ablation for Atrial Fibrillation in Elderly Patients

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Introduction: Catheter ablation (CA) for atrial fibrillation (AF) is widely performed, with a rising proportion of patients of advanced age receiving the procedure. There are limited data describing the experience of index radiofrequency (RF) vs. cryoballoon (CB) ablation for AF among elderly patients in the United States. Hypothesis: CB ablation is associated with better outcomes in elderly patients. Methods: We conducted a retrospective analysis of patients > 75 years undergoing index AF ablation between January 2001 and March 2019 at our center. Major complications and efficacy, defined as freedom from any atrial tachyarrhythmia (ATA) lasting ≥30 seconds after 1 year of follow-up, were assessed in patients with index RF vs. CB ablation. Predictors of ATA recurrence at 1year follow-up were also evaluated. Results: In our cohort of 194 patients, the mean age was 78 + 3.1 years, 58.2% were men, and 39.4% had persistent AF. The mean left atrial (LA) diameter was 4.5 + 0.7, while mean CHA2DS2-VASc score was 3.5 + 1.2. The majority (n=149, 76.8%) underwent RF ablation. The incidence of major complications, including bleeding and cardiac tamponade, was similar in the two sub-groups (RF: 2% vs. CB: 0%, p=0.63). No significant difference in success rate at 1year follow-up was found between patients receiving RF vs. CB ablation (57.7% vs. 64.4% Figure, p=0.94). In a multivariable model adjusting for the age, sex, CHA 2 DS 2 -VASc score, AF type, and index RF vs CB ablation, only LA size was associated with ATA recurrence at 1 year follow-up with each increment of 1 cm in LA size was associated with 1.6-fold greater risk of recurrence [HR=1.59, CI: 1.05-2.41, p=0.02]. Conclusion: In elderly patients undergoing index CA for AF, RF ablation was the predominant modality with similar safety and efficacy relative to CB ablation. LA size was the significant predictor of ATA recurrence at 1year independent of index ablation modality.