医学
心房颤动
内科学
心脏病学
倾向得分匹配
血脂异常
比例危险模型
导管消融
并发症
冲程(发动机)
烧蚀
人口
肺静脉
临床终点
疾病
随机对照试验
工程类
环境卫生
机械工程
作者
Ana Isabel Molina-Ramos,Amalio Ruíz-Salas,Carmen Medina-Palomo,Víctor Manuel Becerra‐Muñoz,Jorge Rodríguez-Capitán,Miguel Romero-Cuevas,Ada del Mar Carmona-Segovia,Ignacio Fernández‐Lozano,Juan José Gómez‐Doblas,Manuel F. Jiménez-Navarro,Francisco Javier Pavón-Morón,Alberto Barrera-Cordero,Javier Alzueta-Rodríguez
标识
DOI:10.14336/ad.2023.0511
摘要
Catheter ablation is a well-established rhythm control therapy in atrial fibrillation (AF).Although the prevalence of AF increases dramatically with age, the prognosis and safety profile of index and repeat ablation procedures remain unclear in the older population.The primary endpoint of this study was to assess the arrhythmia recurrence, reablation and complication rates in older patients.Secondary endpoints were the identification of independent predictors of arrhythmia recurrence and reablation, including information on pulmonary vein (PV) reconnection and other atrial foci.Older (n=129, ≥70 years) and younger (n=129, <70 years) patients were compared using a propensity-score matching analysis based on age, gender, obesity, hypertension, dyslipidemia, diabetes mellitus, dilated left atrium, severe obstructive sleep apnea, cardiac disease, left systolic ventricular function, AF pattern and ablation technique.Arrhythmia recurrence and reablation were evaluated in both groups using a Cox regression analysis in order to identify predictors.During a 30-month follow-up period, there were no significant differences between older and younger patients in the arrhythmia-free survival (65.1% and 59.7%; logrank test p=0.403) and complication (10.1% and 10.9%; p>0.999) rates after the index ablation.However, the reablation rate was significantly different (46.7% and 69.2%; p<0.05, respectively).In those patients who underwent reablation procedure (redo subgroups), there were no differences in the incidence of PV reconnection (38.1% redo-older and 27.8% redo-younger patients; p=0.556).However, the redo-older patients had lower reconnected PVs per patient (p<0.01) and lower atrial foci (2.3 and 3.7; p<0.01) than the redo-younger patients.A further important finding was that age was not an independent predictor of arrhythmia recurrence or reablation.Our data reveal that the AF index ablation in older patients had a similar efficacy and safety profile to younger patients.Therefore, age alone must not be considered a prognostic factor for AF ablation but the presence of limiting factors such as frailty and multiple comorbidities.
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