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Clinical Research in Cardiology

, Volume 108, Issue 2, pp 167–174 | Cite as

Safety and efficacy of cryoballoon ablation for the treatment of atrial fibrillation in elderly patients

  • Amr Abdin
  • Kivanc Yalin
  • Evgeny Lyan
  • Noureddin Sawan
  • Sypridon Liosis
  • Roza Meyer-Saraei
  • Christian Elsner
  • Stefan A. Lange
  • Christian-Hendrik Heeger
  • Charlotte Eitel
  • Ingo Eitel
  • Roland Richard TilzEmail author
Original Paper
  • 148 Downloads

Abstract

Background

Catheter ablation (CA) is an established therapy for treatment of atrial fibrillation (AF). However, data about AF ablation using the cryoballoon (CB) in the elderly population are sparse. The aim of this single center retrospective study is to evaluate the safety and efficacy of CB ablation in patients ≥ 75 years compared to patients < 75 years.

Methods and results

Fifty-five consecutive patients aged ≥ 75 years (elderly group) were compared with 183 patients aged < 75 years (control group). All patients underwent pulmonary vein isolation (PVI) using the second-generation CB. The mean age in the elderly group was 78 ± 2.8 years and 60.8 ± 9.5 in the control group (p < 0.001). During 11.8 ± 5.4 months of follow-up, single procedure success rate for the elderly and the control group was 72.8 and 76%, respectively (p = 0.37). During redo ablation (n = 40), low-voltage areas in the LA were more frequently observed in elderly patients compared to the control group [1.0 (IQR 0–2.0) segments vs 2.0 (IQR 2.0–3.0) segments, respectively, p = 0.03]. The most common complication was transient phrenic nerve palsy, which only occurred in patients < 75 years (0 vs 7, p = 0.33). No severe complication such as procedure-related deaths, atrio-esophageal fistula, or cerebrovascular embolic events occurred.

Conclusions

Our data strengthen the value of CB ablation for the treatment of AF as an effective and safe procedure in elderly patients, with similar success and complication rates when compared with a younger population.

Keywords

Atrial fibrillation Cryoballoon Catheter ablation Elderly 

Notes

Compliance with ethical standards

Conflict of interest

K. Yalin received research and educational grant from Turkish Society of Cardiology. E. Lyan received travel grants and Speaker's Bureau Honoraria from BiosenseWebster, Medtronic, Boston Scientific. R. Tilz received travel grants from St. Jude Medical, Topera, BiosenseWebster, Daiichi Sankyo, Sentrheart and Speaker's Bureau Honoraria from BiosenseWebster, Biotronik, Pfizer, Topera, Bristol-Myers Squibb; Bayer, Sanofi Aventis. Christian Heeger received travel grants and research grants by Medtronic, Claret Medical and SentreHeart. All other authors have no disclosures.

References

  1. 1.
    Heeger C, Tilz RR, Saguner AM, Wick A, Metzner A, Rillig A, Reissmann B, Lemes C, Maurer T, Santoro F, Riedl J, Sohns C, Mathew S, Kuck KH, Ouyang F (2017) Ten-year clinical outcome after circumferential pulmonary vein isolation utilizing the Hamburg approach in patients with symptomatic drug-refractory paroxysmal atrial fibrillation. EP Europace 19(suppl_3):iii143CrossRefGoogle Scholar
  2. 2.
    Bertaglia E, Senatore G, De Michieli L, De Simone A, Amellone C, Ferretto S, La Rocca V, Giuggia M, Corrado D, Zoppo F, Stabile G (2017) Twelve-year follow-up of catheter ablation for atrial fibrillation: a prospective, multicenter, randomized study. Heart Rhythm 14:486–492CrossRefGoogle Scholar
  3. 3.
    Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener H-C, Heidbüchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, Agewall S, Camm J, Baron Esquivias G, Budts W, Carerj S, Casselman F, Coca A, De Caterina R, Deftereos S, Dobrev D, Ferro JM, Filippatos G, Fitzsimons D, Gorenek B, Guenoun M, Hohnloser SH, Kolh P, Lip GYH, Manolis A, McMurray J, Ponikowski P, Rosenhek R, Ruschitzka F, Savelieva I, Sharma S, Suwalski P, Tamargo JL, Taylor CJ, Van Gelder IC, Voors AA, Windecker S, Zamorano JL, Zeppenfeld K (2016) 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace 18:1609–1678CrossRefGoogle Scholar
  4. 4.
    Rillig A, Schmidt B, Di Biase L, Lin T, Scholz L, Heeger C, Metzner A, Steven D, Wohlmuth P, Willems S, Trivedi C, Galllinghouse JG, Natale A, Ouyang F, Kuck KH, Tilz RR (2017) Manual versus robotic catheter ablation for the treatment of atrial fibrillation: the man and machine trial. JACC Clin EP 3:875–883Google Scholar
  5. 5.
    Kuck K-H, Brugada J, Fürnkranz A, Metzner A, Ouyang F, Chun KRJ, Elvan A, Arentz T, Bestehorn K, Pocock SJ, Albenque J-P, Tondo C (2016) Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation. N Engl J Med 374:2235–2245CrossRefGoogle Scholar
  6. 6.
    Go AS, Hylek EM, Phillips KA, Chang Y, Henault LF, Selby JV, Singer DE (2001) Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and risk factors in atrial fibrillation. JAMA 285:2370–2375CrossRefGoogle Scholar
  7. 7.
    Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ (2001) Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 285:2864–2870CrossRefGoogle Scholar
  8. 8.
    Wolf PA, Abbott RD, Kannel WB (1991) Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 22:983–988CrossRefGoogle Scholar
  9. 9.
    Metzner A, Reissmann B, Rausch P, Mathew S, Wohlmuth P, Tilz R, Rillig A, Lemes C, Deiss S, Heeger C, Kamioka M, Lin T, Ouyang F, Kuck KH, Wissner E (2014) One-year clinical outcome after pulmonary vein isolation using the second-generation 28-mm cryoballoon. Circ Arrhythm Electrophysiol 7:288–292CrossRefGoogle Scholar
  10. 10.
    Williams ES, Hall B, Traub D, Bahnson T, Hranitzky P, Zareba W, Daubert JP (2011) Catheter ablation of atrial fibrillation in the elderly. Curr Opin Cardiol 26:25–29CrossRefGoogle Scholar
  11. 11.
    Bulava A, Hanis J, Dusek L (2017) Clinical outcomes of radiofrequency catheter ablation of atrial fibrillation in octogenarians—10-year experience of a one high-volume center. J Geriatr Cardiol 14:575–581Google Scholar
  12. 12.
    Tilz RR, Chun KRJ, Deneke T, Kelm M, Piorkowski C, Sommer P, Stellbrink C, Steven D (2017) Positionspapier der Deutschen Gesellschaft für Kardiologie zur Kardioanalgosedierung. Kardiologe 11:369–382CrossRefGoogle Scholar
  13. 13.
    Kazemian P, Oudit G, Jugdutt BI (2012) Atrial fibrillation and heart failure in the elderly. Heart Fail Rev 17:597–613CrossRefGoogle Scholar
  14. 14.
    Grau AJ1, Weimar C, Buggle F, Heinrich A, Goertler M, Neumaier S, Glahn J, Brandt T, Hacke W, Diener HC (2001) Risk factors, outcome, and treatment in subtypes of ischemic stroke: the German stroke data bank. Stroke 32:2559–2566CrossRefGoogle Scholar
  15. 15.
    Packer DL, Kowal RC, Wheelan KR, Irwin JM, Champagne J, Guerra PG, Dubuc M, Reddy V, Nelson L, Holcomb RG, Lehmann JW, Ruskin JN (2013) STOP AF Cryoablation Investigators. J Am Coll Cardiol 61:1713–1723CrossRefGoogle Scholar
  16. 16.
    Morillo CA, Verma A, Connolly SJ, Kuck KH, Nair GM, Champagne J, Sterns LD, Beresh H, Healey JS, Natale A, RAAFT-2 Investigators (2014) Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation (RAAFT-2): a randomized trial. JAMA 311:692–700CrossRefGoogle Scholar
  17. 17.
    Abugattas JP, Iacopino S, Moran D, De Regibus V, Takarada K, Mugnai G, Ströker E, Coutiño-Moreno HE, Choudhury R, Storti C, De Greef Y, Paparella G, Brugada P, de Asmundis C, Chierchia GB (2017) Efficacy and safety of the second generation cryoballoon ablation for the treatment of paroxysmal atrial fibrillation in patients over 75 years: a comparison with a younger cohort. Europace 19:1798–1803CrossRefGoogle Scholar
  18. 18.
    Metzner I, Wissner E, Tilz RR, Rillig A, Mathew S, Schmidt B, Chun J, Wohlmuth P, Deiss S, Lemes C, Maurer T, Fink T, Heeger C, Ouyang F, Kuck KH, Metzner A (2016) Ablation of atrial fibrillation in patients ≥ 75 years: long-term clinical outcome and safety. Europace 18:543–549CrossRefGoogle Scholar
  19. 19.
    Pott A, Messemer M, Petscher K, Iturbe-Orbe M, Bothner C, Rottbauer W, Dahme T (2017) Clinical outcome of 2nd generation cryoballoon pulmonary vein isolation in patients over 75 years of age. J Cardiol 69:24–29CrossRefGoogle Scholar
  20. 20.
    Tscholl V, Lin T, Lsharaf AK, Bellmann B, Nagel P, Lenz K, Landmesser U, Roser M, Rillig A (2018) Cryoballoon ablation in the elderly: one year outcome and safety of the second-generation 28 mm cryoballoon in patients over 75 years old. Europace 20:772–777CrossRefGoogle Scholar
  21. 21.
    Heeger CH, Tscholl V, Wissner E, Fink T, Rottner L, Wohlmuth P, Bellmann B, Roser M, Mathew S, Sohns C, Reißmann B, Lemeš C, Maurer T, Santoro F, Riedl J, Goldmann B, Landmesser U, Ouyang F, Kuck KH, Rillig A, Metzner A (2017) Acute efficacy, safety, and long-term clinical outcomes using the second-generation cryoballoon for pulmonary vein isolation in patients with a left common pulmonary vein: a multicenter study. Heart Rhythm 1:1111–1118CrossRefGoogle Scholar
  22. 22.
    Shigeta T, Okishige K, Yamauchi Y, Aoyagi H, Nakamura T, Yamashita M, Nishimura T, Ito N, Tsuchiya Y, Asano M, Shimura T, Suzuki H, Kurabayashi M, Keida T, Sasano T, Hirao K (2017) Clinical assessment of cryoballoon ablation in cases with atrial fibrillation and a left common pulmonary vein. J Cardiovasc Electrophysiol 28:1021–1027CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Amr Abdin
    • 1
    • 2
  • Kivanc Yalin
    • 1
    • 3
  • Evgeny Lyan
    • 1
  • Noureddin Sawan
    • 1
  • Sypridon Liosis
    • 1
  • Roza Meyer-Saraei
    • 1
  • Christian Elsner
    • 1
  • Stefan A. Lange
    • 1
  • Christian-Hendrik Heeger
    • 1
  • Charlotte Eitel
    • 1
  • Ingo Eitel
    • 1
    • 2
  • Roland Richard Tilz
    • 1
    • 2
    Email author
  1. 1.University Heart Center Luebeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine)University Hospital Schleswig-HolsteinLuebeckGermany
  2. 2.German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/LuebeckLuebeckGermany
  3. 3.Department of Cardiology, Faculty of MedicineUsak UniversityUsakTurkey

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