Vermeersch Gaëlle, Abugattas Juan-Pablo, Varnavas Varnavas, De Cocker Jeroen, Schwagten Bruno, Sieira Juan, de Asmundis Carlo, Chierchia Gian-Battista, De Greef Yves
Electrophysiology Unit ZNA Heart Centre Middelheim Antwerpen Belgium.
Department of Cardiology Electrophysiology Unit Hôpital Erasme Université Libre de Bruxelles Brussels Belgium.
J Arrhythm. 2021 Mar 26;37(3):626-634. doi: 10.1002/joa3.12531. eCollection 2021 Jun.
It is expected that ablation procedures will be increasingly offered to a more aged population affected with persistent AF (persAF); however, the clinical outcomes of ablation in this specific population are not well described. We aimed to analyze the efficacy and safety of CB-A in this group of patients compared with a younger cohort.
Eighty-three patients with (persAF) aged ≥75 years (group 1; mean age 78.2 ± 3.1 years) and 166 patients also affected with persAF aged <75 years (group 2; mean age 64.3 ± 6.6 years) were included in the study. The primary outcome was freedom from recurrent sustained (>30 seconds) atrial arrhythmias without anti-arrhythmic medication after a blanking period of 3 months. At 2 years, clinical success was achieved in 108 out of 249 patients (43.4%). Median follow-up was 24 months (IQR: 18.4-25.5 months). Older patients suffered from more recurrences than those in the younger cohort ((53/83 patients, 63.9% vs 88/166 patients, 53.0%; = .03). Thirty (12.0%) patients suffered a complication, but the incidence of complications was not different between both groups. The most frequent complication was transient phrenic nerve injury.
The global 2 years efficacy of CB-A PVI in persAF is 43.4%. A lower success rate is achieved in the older patients (36.1%) compared to the younger age group (47.0%). However, the complication rate was not different between age groups.
预计消融手术将越来越多地应用于更多患有持续性房颤（persAF）的老年人群；然而，这一特定人群消融治疗的临床结果尚无详尽描述。我们旨在分析与年轻队列相比，冷冻球囊消融（CB-A）在该组患者中的疗效和安全性。
本研究纳入了83例年龄≥75岁的持续性房颤患者（第1组；平均年龄78.2±3.1岁）和166例年龄<75岁的持续性房颤患者（第2组；平均年龄64.3±6.6岁）。主要结局是在3个月的空白期后，无需使用抗心律失常药物即可免于复发性持续性（>30秒）房性心律失常。2年时，249例患者中有108例（43.4%）取得临床成功。中位随访时间为24个月（四分位间距：18.4 - 25.5个月）。老年患者的复发次数多于年轻队列中的患者（（53/83例患者，63.9% 对比 88/166例患者，53.0%；P = 0.03）。30例（12.0%）患者出现并发症，但两组并发症发生率无差异。最常见的并发症是短暂性膈神经损伤。
CB-A肺静脉隔离术治疗持续性房颤的2年总体疗效为43.4%。与年轻组（47.0%）相比，老年患者的成功率较低（36.1%）。然而，不同年龄组的并发症发生率无差异。
