Division of Cardiology, Mauriziano Umberto I Hospital, Corso Filippo Turati, 62, Turin, 10128, Italy.
Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
J Interv Card Electrophysiol. 2023 Jan;66(1):179-192. doi: 10.1007/s10840-021-01007-w. Epub 2021 Aug 26.
Data regarding the age-specific outcomes of VT ablation in patients with structural heart disease (SHD) are scarce. We performed a systematic review and meta-analysis to evaluate the outcomes of VT ablation in elderly vs. younger patients with SHD.
MEDLINE/PubMed, Cochrane, and Google Scholar and references comparing VT ablation in elderly vs. younger patients were screened and studies included if matching inclusion and exclusion criteria.
Five retrospective studies enrolling 2778 SHD patients (868 elderly vs. 1910 younger) were included. Compared to younger subjects, the elderly showed similar results in terms of acute ablation success (OR 0.78, 95% CI 0.54-1.13, p = 0.189) and minor complications (OR 1.74, 95% CI 0.74-4.09, p = 0.205), a trend toward a higher risk of major complications (OR 2.30, 95% CI 0.83-6.40, p = 0.110) and significantly higher rates of all complications (OR 2.67, 95% CI 1.51-4.71, p = 0.001) and periprocedural mortality (OR 1.93, 95% CI 1.24-3.01, p = 0.004). At a mean follow-up of 18 months, elderly patients showed similar long-term VT recurrence rate (OR 1.02, 95% CI 0.85-1.22, p = 0.861) and higher all-cause mortality (OR 2.00, 95% CI 1.40-2.86, p < 0.001). In elderly patients, urgent VT ablation is associated with higher risk of major complications (beta = 0.06, p < 0.001) and periprocedural mortality (beta = 0.03, p = 0.029), while advanced age is associated with higher risk of major complications (beta = 0.29 with p = 0.009) and all complications + periprocedural mortality (beta = 0.17 with p = 0.037).
Compared to younger patients, VT ablation in elderly showed similar results in terms of acute ablation success and long-term VT recurrence rate with a significantly higher risk of all complications, periprocedural mortality, and long-term mortality, especially when the procedure is performed urgently and in the most aged patients. Large prospective multicenter randomized trials are required to confirm these findings.
关于结构性心脏病（SHD）患者中特定年龄的 VT 消融结局的数据很少。我们进行了一项系统评价和荟萃分析，以评估老年与年轻 SHD 患者 VT 消融的结局。
筛选了比较老年与年轻 SHD 患者 VT 消融的 MEDLINE/PubMed、Cochrane 和 Google Scholar 及参考文献，并纳入了符合纳入和排除标准的研究。
纳入了 5 项回顾性研究，共纳入 2778 例 SHD 患者（868 例老年与 1910 例年轻）。与年轻患者相比，老年患者在急性消融成功率（OR 0.78，95%CI 0.54-1.13，p=0.189）和轻微并发症（OR 1.74，95%CI 0.74-4.09，p=0.205）方面的结果相似，主要并发症（OR 2.30，95%CI 0.83-6.40，p=0.110）和所有并发症（OR 2.67，95%CI 1.51-4.71，p=0.001）和围手术期死亡率（OR 1.93，95%CI 1.24-3.01，p=0.004）的风险更高。在平均 18 个月的随访中，老年患者的 VT 复发率（OR 1.02，95%CI 0.85-1.22，p=0.861）和全因死亡率（OR 2.00，95%CI 1.40-2.86，p<0.001）相似。在老年患者中，紧急 VT 消融与主要并发症（β=0.06，p<0.001）和围手术期死亡率（β=0.03，p=0.029）的风险增加相关，而年龄较大与主要并发症（β=0.29，p=0.009）和所有并发症+围手术期死亡率（β=0.17，p=0.037）的风险增加相关。
与年轻患者相比，老年患者 VT 消融在急性消融成功率和长期 VT 复发率方面的结果相似，但所有并发症、围手术期死亡率和长期死亡率的风险显著增加，尤其是在紧急情况下和最年长的患者中进行时。需要进行大型前瞻性多中心随机试验来证实这些发现。
