Background:
Atrioventricular nodal reentrant tachycardia (AVNRT) is typically considered a benign and curable arrhythmia, but evidence on ablation in patients ≥80 years is limited. This study evaluated the acute efficacy and safety of slow pathway ablation/modulation (SPA/SPM) in octogenarians and compared complication rates to a comprehensive institutional AVNRT cohort.
Methods:
All patients ≥80 years undergoing first-time SPA/SPM between 2001 and 2024 were retrospectively analysed and screened for relevant characteristics (Table 1). Procedures were performed under deep sedation using a standardized protocol. The primary efficacy endpoint was non-inducibility of AVNRT. Safety endpoints included AV Block (AVB), pericardial effusion (PE) and puncture site bleeding/ vascular complications. Results were compared with the complete SPA/SPM cohort of our institution excluding octogenarians (n = 6,020).
Results:
A total of 106 patients (mean age 83.6 years; 41.5% male) were included. SPA was performed in 64 cases (60.4%) and SPM in 40 (37.7%); Two procedures were prematurely terminated due to a transient AVB/ conduction delay, acute success was achieved in 98.1%. Two patients (1.9%) developed persistent AVB, one requiring pacemaker implantation (PPI), the other already underwent PPI prior to ablation due to sick sinus syndrome (SSS). PE requiring drainage occurred in two patients (1,9%), one of these was on oral anticoagulation (OAC) prior to ablation. Four patients (3,8%) experienced puncture site bleeding, including one requiring surgical intervention. All four patients were receiving anti-plateled therapy (APT) before ablation. Mean hospital stay was 1.3 days. Within our comparison cohort, persistent AVB occurred in 0.12%, PE in 0.08%, and major bleeding in 0.37% (Table 2).
Conclusion:
Although the acute efficacy in octogenarians undergoing SPA/SPM is high, the complication rates were markedly elevated compared to a large comparison cohort. One possible explanation might be a relatively high rate of OAC/ APT in this cohort. Furthermore, age-related degenerative changes in the conduction system could provide a possible explanation for an increased risk of procedure-associated AVB. Catheter ablation remains an effective treatment option for symptomatic elderly patients but individualized risk assessment and optimized periprocedural management are essential.
Table 1. Baseline Characteristics of Patients
Total number of patients, n 106
Age (years), meean (range) 83.6 (80–93)
Male patients, n (%) 44 (41.5%)
OAC, n (%) 25 (23.6%)
APT, n (%) 40 (37.7%)
Table 2. Procedural Complications in elderly and the comparison cohort
Complication ≥80 years (n=106) Comparison cohort (n=6,020) Percentage
Persistent AVB 2 7 1.9 % vs 0.12 %
PE 2 5 1.9 % vs 0.08 %
Hematoma / groin bleeding 4 22 3.8 % vs 0.37 %
