Ablation of ventricular tachycardia in the very elderly patient with cardiomyopathy: how old is too old?

BACKGROUND

Because of the disputable effectiveness of the implantable cardioverter-defibrillator (ICD) in very elderly patients, it is reasonable to consider catheter ablation of scar-related ventricular tachycardia (VT) at an earlier stage of the therapeutic cascade, especially in those who have refused ICD implantation.

METHODS

Analysis of 53 VT ablations performed in our tertiary centre in patients with ischemic or nonischemic dilated cardiomyopathy who were ≥ 60 years of age. We assessed the safety and acute effectiveness of the procedure in 14 very elderly patients (age ≥ 80 years), follow-up all-cause mortality and rates of ICD therapies during follow-up. Furthermore, we established a comparison between very elderly patients and: (1) 34 patients aged 60-79 years having the same procedure; and (2) 11 octogenarian patients with ischemic or nonischemic cardiomyopathy, documented ventricular fibrillation or sustained VT, subsequent secondary prevention ICD implantation and at least 1 ICD therapy after implantation.

RESULTS

Complete acute success was achieved in 80% of procedures in very elderly patients vs 91.7% in younger individuals. Three complications occurred in the former, including 1 periprocedural death not directly related to the procedure itself, and 2 were seen in the latter. A 6-month 27.3% occurrence of any ICD therapy was seen in the very elderly group (with only 1 patient who required an ICD shock), and the 6-month incidence of ICD therapies in the younger group was 32%. All 11 control octogenarian ICD patients had further ICD therapies after their first ICD intervention.

CONCLUSIONS

Ablation of VT in very elderly patients seems relatively safe and as effective as in younger patients.