Efficacy and safety of catheter ablation in octogenarians

Zado, Erica S.; Callans, David J.; Gottlieb, Charles; Kutalek, Steven P.; Wilbur, Sabrina L.; Samuels, Fania L.; Hessen, Scott E.; Movsowitz, Colin; Fontaine, John M.; Kimmel, Stephen E.; Marchlinski, Francis E.

doi:10.1016/s0735-1097(99)00544-6

Cited by 58 publications

(48 citation statements)

References 12 publications

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“…Surgical ablation of an arrhythmogenic focus has been shown to be a beneficial therapy for selected patients with mainly monomorphic VT. 73) The efficacy and safety of catheter ablation in octogenarians has been studied and appears to be comparable to younger patients. 74) This study included 37 patients greater than 80 years of age in comparison to 758 younger patients and found no difference in ablative success or compli-cation rates amongst the two groups. The major limitation of this study was the small sample size for which only 3 elderly patients underwent VT ablation with a short-term success rate of only 66%.…”

Section: Procedural Therapiesmentioning

confidence: 78%

Ventricular Arrhythmias in the Elderly

Minor

Akiyama

2006

Journal of Arrhythmia

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The management of malignant ventricular arrhythmias will become gradually more important as life expectancy continues to increase. The incidence of sudden cardiac death and overall cardiac mortality is more pronounced in the elderly mainly as a reflection of the higher prevalence of ischemic heart disease. With the exception of beta‐blocker therapy, antiarrhythmic drug therapy has not proven to be effective in the prevention of sudden cardiac death. Implantable cardioverter‐defibrillator therapy has been shown to reduce both overall mortality and arrhythmic death when following current guidelines for implantation and appears to be applicable to any age group when sensible patient selection is implemented. The greater efficacy of this therapy relative to antiarrhythmic therapies supports its expanded use in the elderly population. Such therapy has a similar cost‐effectiveness to other accepted interventions and does not appear to be associated with reduced quality of life or age‐specific complications. The clinical approach to elderly patients at risk of sudden death from ventricular arrhythmias will continue to evolve as new technologies are developed, but the future of ventricular arrhythmia treatment in the elderly will likely emphasize an increasing utilization of both implantable cardioverter‐defibrillator and beta‐blocker therapies.

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Section: Procedural Therapiesmentioning

confidence: 78%

Ventricular Arrhythmias in the Elderly

Minor

Akiyama

2006

Journal of Arrhythmia

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“…Previous studies of elective RFCA in patients 80 years or older have also revealed a good efficacy 12 15 . In a study 12 demonstrating Fig. 2 The estimated survival rates after hospital discharge.…”

Section: Catheter Ablation In Very Elderly Personsmentioning

confidence: 99%

“…Another study 13 of RFCA in 131 consecutive geriatric patients ranging in age from 80 to 92 years old for a success rate exceeding 97% for all targeted arrhythmias. In these studies 12,13 , most of the targeted arrhythmias were AVNRT, common-type AFL, and a His bundle ablation. Recently, the results of AF ablation (isolation of all pulmonary veins with or without additional lesions), which requires a more complicated process to be completed, have been reported.…”

Section: Catheter Ablation In Very Elderly Personsmentioning

confidence: 99%

Urgent Catheter Ablation in Octogenarians with Serious Tachyarrhythmias

et al. 2016

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Background: Urgent catheter ablation is often required for various tachyarrhythmias; however, its efficacy and safety in elderly patients have not been fully elucidated.Methods: This study included consecutive octogenarians who underwent urgent radiofrequency catheter ablation (RFCA) for various serious tachyarrhythmias (urgent group, n=28) that were lifethreatening, hemodynamically deleterious, or provoking ischemia, and consecutive octogenarians who underwent elective RFCA (control group, n=36). The rate of a successful RFCA, complications, later arrhythmia recurrences, and mortality were compared between the groups.Results: There was no significant difference in the breakdown of the targeted arrhythmias between the groups, and common-type atrial flutter was most often targeted in both the urgent group (57%) and the elective group (56%). Compared with the control group patients, the patients of the urgent group were older (84 3 vs. 82 2 years P=0.001), with a higher frequency of baseline heart disease (68% vs. 17%, P <0.001) and lower left ventricular ejection fraction (45% 15% vs. 68% 10%, P<0.001). The rates of acute success (100% vs. 100%, P=1.00) and later arrhythmia recurrences (4% vs. 14%, P=0.22) were comparable between the groups. Two patients in the urgent group and 2 in the elective group had procedure-related nonlethal complications (7% vs. 6%, P=1.00): groin hematoma in 2, pressure ulcer in 1, and CO2 narcosis in 1. There were no in-hospital deaths, and mortality during follow-up did not differ between the urgent and elective groups (6.0% vs. 3.9% per year, log-rank P=0.38). Conclusion:Even in octogenarian patients, urgent catheter ablation for serious tachyarrhythmias can be safely performed with a high success rate and acceptable prognosis. (J Nippon Med Sch 2016; 83: 62 70)

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“…Inadvertent complete or second-degree atrioventricular block are the most common complications and occur in 1-1·3% of patients [1,2] . Catheter ablation can be performed effectively and safely, even in the very elderly [3] . These remarkable developments have rekindled interest in the anatomy and electrophysiology of the atrioventricular node.…”

Section: See Page 89 For the Article To Which This Editorial Refersmentioning

confidence: 99%