Safety and efficacy of radiofrequency ablation of common atrial flutter in elderly patients: a single center prospective study.

Little data is available concerning the invasive treatment of atrial flutter (AFL) in elderly patients. The purpose of this prospective study was to evaluate the risks, safety, and follow-up of radiofrequency (RF) catheter ablation of common AFL in patients >75 years old (n = 61) (Group I) compared to patients younger than 75 years (n = 187) (Group II). The study population consisted of 248 patients (81% men/19% women), 21 to 96 years old (mean 66.3 +/- 12 years) with AFL, referred for RF from June 1999 to June 2001. RF endpoint was the assessment of the bidirectional block. The cumulative risk of atrial fibrillation (AF) was analyzed by the Kaplan-Meier method and log-rank test. The mean follow-up was 12.4 +/- 9 months. No complication occurred. Group I (80.1 +/- 4.5 years) did not differ significantly from Group II (61 +/- 11 years) regarding: AF history before ablation (34.4% vs 39.8%), structural heart disease (54% vs 42%), LVEF (57%+/- 12% vs 58%+/- 12%), left atrial size (43.8 +/- 7 vs 42.5 +/- 7), cava-tricuspid isthmus dimension (40 +/- 10 vs 39 +/- 4 mm), bidirectional block (100% vs 96.2%), RF application (12.5 +/- 10 vs 13.5 +/- 12 minutes), AFL recurrence (3.3% vs 5.3%), antiarrhythmic agents at hospital discharge (34.4% vs 38.9%), mean follow-up (12 +/- 9 vs 13 +/- 9 months) and AF occurrence (29.5% vs 20.3%; P = 0.2). Of these, the incidence of AF in patients without prior history (n = 150) was 7 (18%) of 39 for Group I and 11 (10%) of 111 for Group II (P = 0.1) after follow-up. Catheter ablation of AFL in very elderly patients appears to be a reasonable approach regarding feasibility, effectiveness, and low procedural risk.