High-power short-duration vs conventional radiofrequency ablation for atrial fibrillation in patients over 80 years of age: A propensity-score matched cohort analysis.

BACKGROUND

Data on atrial fibrillation (AF) ablation using high-power short-duration (HPSD) ablation in patients over 80 years are lacking.

OBJECTIVE

This study aimed to compare the safety and efficacy of paroxysmal and persistent AF ablation using an HPSD (60-90 W/4-8 sec) vs conventional ablation (30-40 W/30 sec) in a propensity score-matched cohort of patients older than 80 years.

METHODS

Overall, 232 consecutive patients aged over 80 years undergoing AF ablation were included. Propensity score matching revealed 102 pairs for maximizing comparability. A post-ablation 42-day blanking period was applied. Major complications were defined as those requiring intervention or causing sequels within 30 days following catheter ablation.

RESULTS

Procedural duration (132.7 ± 45.7 vs 155.4 ± 59.7 min; = .0062) and x-ray exposure (dose area product 248.9 ± 313.6 vs 544.9 ± 704.7 cGycm; = .0002) were significantly reduced in the HPSD group. Safety end points showed no significant differences (4/102 vs 7/102; .54). Freedom from any arrhythmia was not different between the groups including a follow-up of 22.5 ± 22.7 months (hazard ratio, 0.71; 95% confidence interval, 0.48-1.06 for the HPSD approach). After 1.52 ± 0.79 procedures, 80.4 % of all patients remained in sinus rhythm with a lower number of repeat procedures in the HPSD group (1.38 ± 0.65 vs 1.65 ± 0.90; = .038).

CONCLUSIONS

In very old patients (>80 years), AF ablation using an HPSD approach can be performed safely and effectively with a reduction of procedure duration, x-ray exposure, and fewer repeat ablations compared to a conventional approach. Long-term ablation results are promising with both approaches.