1Herz- und Diabeteszentrum NRW Klinik für Elektrophysiologie/ Rhythmologie Bad Oeynhausen, Deutschland; 2Asklepios Klinik Nord - Heidberg Abteilung für Kardiologie Hamburg, Deutschland; 3Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland; 4Asklepios Proresearch Hamburg, Deutschland; 5Universitätsklinikum Schleswig-Holstein Klinik für Rhythmologie Lübeck, Deutschland; 6Universitäres Herz- und Gefäßzentrum Hamburg Allgemeine und Interventionelle Kardiologie Hamburg, Deutschland; 7Universitätsklinikum Essen Klinik für Kardiologie und Angiologie Essen, Deutschland; 8Krankenhaus der Elisabethinen Innere Medizin II- Kardiologie Linz, Österreich; 9Universitätsspital Kardiologie Zürich, Deutschland; 10Asklepios Klinik St. Georg Kardiologie & internistische Intensivmedizin Hamburg, Deutschland; 11Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie Hamburg, Deutschland; 12LANS Cardio Hamburg Kardiologie Hamburg, Deutschland
Background Catheter ablation is an established treatment for cardiac arrhythmia. There is a lack of data on invasive electrophysiological (EP) procedures in aged patients.
Methods We retrospectively studied procedural characteristics, periprocedural adverse events in patients >80 years who underwent catheter ablation or left atrial appendage closure (LAAC) procedures performed 2005 to 2017 at a high-volume center. Patients were compared to a control group of individuals <80 years of age.
Results A total of 566 procedures were performed on 486 patients with a mean age of 82.7±2.5 years (range 80-95 years). A cohort of 578 patients aged <80 years who underwent 592 EP procedures served as control group. Baseline characteristics of the patient groups are shown in Table 1. At least one major complication occurred in 31 procedures in the study group (5.7%) (AF/AT 5.1% [Cryoballoon ablation 3.1%], cavotricuspid isthmus (CTI) ablation 2.2%, AVN ablation 5.9%, SVT 3.0%, PVC 23.5%, endo- or epicardial VT 15.0%, LAAC 16.7%) (Figure 1). The frequency of intrahospital death was 1.1% for AF/AT ablation, 0.7% for CTI ablation, 0.0% for AVN/SVT/PVC ablation, 2.5% for VT ablation and 8.3% for LAAC procedures (Figure 1).
Logistic regression revealed presence of structural heart disease (OR 2.38, P=0.0067), procedure duration (Odds ratio 1.98, P=0.0483), contrast medium volume (OR 2.22, P=0.0262) and type of procedure (other than AF/AT and CTI) (OR 1.96, P=0.0499) as factors on occurrence of complications and death. There was a statistical trend to more frequent major complications and intrahospital death in the study group (Table 1).
Conclusion Interventional EP procedures were feasible in octogenarians and nonagenarians with acceptably low complications rates in procedures for atrial arrhythmias. Nevertheless, procedures for treatment of ventricular arrhythmias and LAAC were associated with high complication rates and there was a statistical trend for higher rates of complications and mortality in aged patients as compared to younger indiciduals. Our results warrant an individual risk-benefit assessment for aged patients to the decision to perform invasive EP procedures.
Table 1 Baseline data
|
|
Aged patients |
Control group | |
|
Parameter |
n (%) or mean±SD |
n (%) or mean±SD |
P value |
|
Patients/procedures |
486/566 |
578/592 | |
|
Mean Age (years) |
82.7±2.5 |
63.2±13.2 |
<0.001 |
|
Mean EF (%) |
56.7±13.6 |
53.9±11.4 |
<0.001 |
|
EF<50 %, n (%) |
31 (5.5) |
123 (20.8) |
<0.001 |
|
EF<30 %, n (%) |
12 (2.1) |
27 (4.6) |
0.021 |
|
Previous myocardial infarction, n (%) |
56 (9.9) |
80 (13.5) |
0.056 |
|
Arterial hypertension, n (%) |
415 (73.3) |
398 (67.2) |
0.023 |
|
Diabetes Mellitus, n (%) |
70 (12.4) |
78 (13.2) |
0.68 |
|
Kidney failure, n (%) |
129 (22.8) |
40 (6.8) |
<0.001 |
|
Previous stroke or TIA, n (%) |
50 (8.8) |
40 (6.8) |
0.19 |
|
Type of procedure | |||
|
AF/AT |
256 (45.2) |
281 (47.5) |
0.45 |
|
CTI |
139 (25.0) |
138 (23.3) |
0.62 |
|
AVN ablation |
17 (3.0) |
21 (3.5) |
0.60 |
|
SVT |
66 (11.7) |
74 (12.5) |
0.66 |
|
PVC |
17 (0.7) |
24 (4.1) |
0.33 |
|
VT endo |
39 (1.6) |
38 (6.4) |
0.75 |
|
VT epi |
1 (1.1) |
5 (0.8) |
0.11 |
|
LAAC |
12 (3.0) |
12 (2.0) |
0.66 |
|
At least one major complication |
33 (5.8) |
21 (3.5) |
0.07 |
|
Bleeding at vascular access |
14 (2.5) |
13 (2.2) | |
|
Cardiac tamponade |
8 (1.4) |
5 (0.8) | |
|
Pulmonary embolism |
2 (0.4) |
0 (0.0) | |
|
Stroke |
2 (0.4) |
1 (0.2) | |
|
Respiratory failure |
2 (0.4) |
0 (0.0) | |
|
Permanent pacemaker therapy |
2 (0.4) |
0 (0.0) | |
|
Pneumothorax with drainage |
2 (0.4) |
0 (0.0) | |
|
Phrenic nerve palsy |
1 (0.2) |
1 (0.2) | |
|
Gastroparesis |
0 (0.0) |
1 (0.2) | |
|
Death |
6 (1.1) |
1 (0.2) |
0.051 |
|
Minor complications n (%) |
29 (5.1) |
19 (3.2) |
0.10 |
Figure 1