Federico Cecchini1,2,3, Giacomo Mugnai4, Saverio Iacopino5, Juan Pablo Abugattas4,6, Bert Adriaenssens6, Maysam Al-Housari4, Alexandre Almorad4, Gezim Bala4, Antonio Bisignani4, Carlo de Asmundis4, Yves De Greef6, Riccardo Maj4, Thiago G Osòrio4, Luigi Pannone4, Bruno Schwagten6, Juan Sieira4, Antonio Sorgente4, Erwin Stroker4, Michael Wolf6, Gian-Battista Chierchia4. 1. Electrophysiology Unit, Maria Cecilia Hospital, Via Corriera, 1, 48033, Cotignola, RA, Italy. cecchinifederico1989@gmail.com. 2. Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Avenue du Laerbeek 101, 1090, Jette, Brussels, Belgium. cecchinifederico1989@gmail.com. 3. Electrophysiology Unit, ZNA Middelheim, Lindendreef 1, 2020, Antwerp, Antwerp, Belgium. cecchinifederico1989@gmail.com. 4. Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Avenue du Laerbeek 101, 1090, Jette, Brussels, Belgium. 5. Electrophysiology Unit, Maria Cecilia Hospital, Via Corriera, 1, 48033, Cotignola, RA, Italy. 6. Electrophysiology Unit, ZNA Middelheim, Lindendreef 1, 2020, Antwerp, Antwerp, Belgium.
Abstract
BACKGROUND: Cryoballoon technology (CB-A) has become a cornerstone of atrial fibrillation (AF) ablation in terms of safety and efficacy. Data regarding CB-A in octogenarians are still scarce and limited to single center experiences. The present study sought to analyze the performances of index CB-A in patients older than 80 years-old referring to 3 high-volume European centers. METHODS AND RESULTS: We retrospectively enrolled 95 patients with a median age of 81 [80, 83] years. 62 (65.3%) patients presented with paroxysmal AF and 33 (33.7%) with persistent AF. Mean procedure and fluoroscopy times were 73.8 ± 25.2 and 15.3 ± 7.5 min, respectively. At 12 months and 24 months of follow-up, the overall freedom from AF was 81.1% and 66.6%, respectively. When divided for AF type, freedom from AF was higher in patients with paroxysmal AF (p = 0.007). Cryoballoon ablation was able to significantly improve AF-related symptoms as proven by the significant decrease in EHRA score during the follow-up (p < 0.0001). Phrenic nerve palsy occurred in 8 (8.5%) patients and always resolved during the procedure without affecting procedural outcome. Two major complications occurred (2.1%); one patient experienced pneumonia, successfully treated with antibiotics and non-invasive mechanical ventilation, the latter one experienced acute kidney failure secondary to urosepsis successfully treated by renal replacement therapy. CONCLUSIONS: The present study showed that CB-A is a feasible and effective procedure among octogenarians with a low complication rate. Contemporarily, CB-A can help to alleviate arrhythmia-related symptoms also among this group of subjects.
BACKGROUND: Cryoballoon technology (CB-A) has become a cornerstone of atrial fibrillation (AF) ablation in terms of safety and efficacy. Data regarding CB-A in octogenarians are still scarce and limited to single center experiences. The present study sought to analyze the performances of index CB-A in patients older than 80 years-old referring to 3 high-volume European centers. METHODS AND RESULTS: We retrospectively enrolled 95 patients with a median age of 81 [80, 83] years. 62 (65.3%) patients presented with paroxysmal AF and 33 (33.7%) with persistent AF. Mean procedure and fluoroscopy times were 73.8 ± 25.2 and 15.3 ± 7.5 min, respectively. At 12 months and 24 months of follow-up, the overall freedom from AF was 81.1% and 66.6%, respectively. When divided for AF type, freedom from AF was higher in patients with paroxysmal AF (p = 0.007). Cryoballoon ablation was able to significantly improve AF-related symptoms as proven by the significant decrease in EHRA score during the follow-up (p < 0.0001). Phrenic nerve palsy occurred in 8 (8.5%) patients and always resolved during the procedure without affecting procedural outcome. Two major complications occurred (2.1%); one patient experienced pneumonia, successfully treated with antibiotics and non-invasive mechanical ventilation, the latter one experienced acute kidney failure secondary to urosepsis successfully treated by renal replacement therapy. CONCLUSIONS: The present study showed that CB-A is a feasible and effective procedure among octogenarians with a low complication rate. Contemporarily, CB-A can help to alleviate arrhythmia-related symptoms also among this group of subjects.
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