Impact of age on atrial arrhythmia recurrence following cryoballoon pulmonary-vein isolation

Abstract

Abstract Background 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 it remains unclear whether there is an age limit for ablation and whether the potential benefits of catheter ablation justify the potentially increased complication rate in elderly. Objective To prospectively analyze the impact of age on efficacy and safety of cryoballoon ablation (CBA). Methods ; We prospectively analyzed consecutive patients who underwent CBA in a single-center cohort between 2018 and 2023. Patients were stratified by age (<75yrs versus ≥75yrs) and AF type. Primary efficacy endpoint was recurrence of atrial arrhythmia after 90-day blanking period. Linear and spline regression were used to assess the association between age and primary efficacy endpoint. Safety endpoints were death, stroke or procedure-related complications. Results 873 patients underwent CBA (525 paroxysmal, 348 persistent AF). Median follow-up was 18-months. At 1-year, primary efficacy endpoint occurred in 19.6% (71/363) of young (<75yrs) versus 27.8% (45/162) of elderly (≥75yrs) patients with paroxysmal AF (HR 0.62; 95%CI, 0.41-0.92; P=0.019; fig. 1A) and in 25.0% (57/228) of young versus 39.2% (47/120) of elderly patients with persistent AF (HR 0.57; 95%CI, 0.37-0.85; P=0.006; fig. 1B). A significant linear relationship between age and primary efficacy endpoint occurrence was found for both paroxysmal (P=0.01) and persistent AF (P=0.002; fig.2) while spline regression was non-significant (P=0.45/ P=0.12). No difference was observed regarding the incidence of safety endpoints between young and elderly patients (P=0.76). Conclusion Atrial arrhythmia recurrence rate after CBA increases linearly with age (thus not allowing determination of a clear "cut-off-age") and is highest in elderly patients (≥75 yrs) with persistent AF. Safety of CBA in elderly is comparable to patients of younger age.