Bhargava Mandeep, Marrouche Nassir F, Martin David O, Schweikert Robert A, Saliba Walid, Saad Eduardo B, Bash Dianna, Williams-Andrews Michelle, Rossillo Antonio, Erciyes Demet, Khaykin Yaariv, Burkhardt J David, Joseph George, Tchou Patrick J, Natale Andrea
Center for Atrial Fibrillation, Section of Pacing and Electrophysiology, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J Cardiovasc Electrophysiol. 2004 Jan;15(1):8-13. doi: 10.1046/j.1540-8167.2004.03266.x.
A retrospective analysis was performed to define the impact of age on the outcomes and complications in patients undergoing pulmonary vein isolation (PVI). PVI is an evolving technique for the management of atrial fibrillation (AF). The impact of age on the risks, outcomes, and complications of PVI has not been well defined.
A total of 323 patients (259 men and 64 women; age 18-79 years) underwent PVI for treatment of drug-refractory symptomatic AF. An ostial isolation of the pulmonary veins was done using a cooled-tip ablation catheter guided by circular mapping. The patients were divided into three groups based on age (group I: <50 years, group II: 51-60 years, group III: >60 years) and the results were compared. There were 106 patients in group I, 114 patients in group II, and 103 patients in group III (mean age 41.3 +/- 7.8 years, 55.4 +/- 2.75 years, and 66.6 +/- 4.18 years, respectively) who underwent PVI for paroxysmal (53.8%), persistent (10.8%), or permanent (35.3%) AF. Baseline characteristics were similar except for a higher prevalence of hypertension and/or structural heart disease in groups II and III (58% and 63% vs 33% in group I, respectively). The procedural variables were similar in all age groups. The overall risk of complications was similar in the three groups, except that the risk of stroke was significantly higher in patients >60 years of age (3% vs 0%; P < 0.05). The recurrence rates of AF were similar in the three age groups (15.1%, 16.7%, and 18.4%, respectively; P > 0.05). The risk of severe pulmonary vein stenosis (1.8%, 2.6%, and 0.9%, respectively) was low and did not vary with age.
PVI is a safe and effective treatment for patients with drug-refractory symptomatic AF, and its benefits extend to all age groups. The risk of procedural complications, especially thromboembolic events, appears to be higher in the elderly age group. This observation needs to be considered while assessing potential candidates for the procedure.
进行了一项回顾性分析，以确定年龄对接受肺静脉隔离（PVI）患者的治疗结果和并发症的影响。PVI是一种用于治疗心房颤动（AF）的不断发展的技术。年龄对PVI的风险、结果和并发症的影响尚未明确界定。
共有323例患者（259例男性和64例女性；年龄18 - 79岁）接受PVI治疗药物难治性症状性AF。使用环形标测引导的冷盐水灌注消融导管进行肺静脉口部隔离。根据年龄将患者分为三组（I组：<50岁，II组：51 - 60岁，III组：>60岁），并比较结果。I组有106例患者，II组有114例患者，III组有103例患者（平均年龄分别为41.3±7.8岁、55.4±2.75岁和66.6±4.18岁），接受PVI治疗阵发性（53.8%）、持续性（10.8%）或永久性（35.3%）AF。除II组和III组高血压和/或结构性心脏病患病率较高（分别为58%和63%，而I组为33%）外，基线特征相似。所有年龄组的手术变量相似。三组并发症的总体风险相似，但>60岁患者的中风风险显著更高（3%对0%；P<0.05）。三个年龄组AF的复发率相似（分别为15.1%、16.7%和18.4%；P>0.05）。严重肺静脉狭窄的风险较低（分别为1.8%、2.6%和0.9%），且不随年龄变化。
PVI是治疗药物难治性症状性AF患者的一种安全有效的治疗方法，其益处适用于所有年龄组。手术并发症的风险，尤其是血栓栓塞事件，在老年组似乎更高。在评估该手术的潜在候选者时需要考虑这一观察结果。
