背景:导管消融在老年心房颤动(AF)患者中的作用尚不清楚。脉冲场消融(PFA)显示出良好的临床特征,然而,缺乏老年患者的数据。
目的:我们旨在评估PFA在老年人中的安全性和有效性,使用来自EU-PORIA注册表的数据。
方法:比较了80岁以上患者和年轻患者使用pentasplinePFA导管(Farapulse™)进行房颤消融术的围手术期并发症以及长期安全性和疗效结果。横跨七个欧洲中心。
结果:在注册的1233名患者中,88(7.1%)年龄超过80岁。老年患者更多是女性(51.1%vs37.8%,p=0.01),BMI中位数较低(26.0,IQR:23.5-29.2vs26.9,IQR:24.4-30.4kg/m2,p=0.02),CHA2DS2-VASc评分中位数较高(4,IQR:3-5vs2,IQR:1-3,p<0.001),高血压发病率较高(73.9%vs52.7%,p<0.001)。在这两组中,大多数患者有阵发性房颤(58.0%vs60.3%,p=0.65)。老年人的消融更频繁地进行了最低限度的中断抗凝(87.5%vs59.7%,p<0.001)。尽管总体并发症发生率相当(5.7%vs3.5%,p=0.29),老年患者卒中发生率较高(2.3%vs0.3%,p=0.04)。12个月时,主要不良临床事件(4.5%vs.2.1%,p=0.12)和无心律失常生存率(70%vs74%,p=0.69)在两组中具有可比性。随访结束时,无复发的老年患者均未服用抗心律失常药物。
结论:在这个现实世界中,在老年和年轻患者中,PFA治疗房颤的疗效相似.尽管并发症发生率相当,老年人的卒中发生率较高.
BACKGROUND: The role of catheter ablation in elderly patients with atrial fibrillation (AF) is unclear. Pulsed field ablation (PFA) demonstrates a favorable clinical profile, however, data on elderly patients are lacking.
OBJECTIVE: We aimed to assess the safety and efficacy of PFA in the elderly, using data from the EU-PORIA registry.
METHODS: Periprocedural complications and long-term safety and efficacy outcomes of AF ablation using the pentaspline PFA catheter (Farapulse™) were compared between patients older than 80 years old and their younger counterparts, across seven European centers.
RESULTS: Among the 1233 patients in the registry, 88 (7.1 %) were older than 80 years. Elderly patients were more often females (51.1 % vs 37.8 %, p = 0.01) with a lower median BMI (26.0, IQR:23.5-29.2 vs 26.9, IQR:24.4-30.4 kg/m2, p = 0.02), a higher median CHA2DS2-VASc score (4, IQR:3-5 vs 2, IQR:1-3, p < 0.001) and a higher incidence of hypertension (73.9 % vs 52.7 %, p < 0.001). In both groups, most patients had paroxysmal AF (58.0 % vs 60.3 %, p = 0.65). Ablation in the elderly was more frequently performed with minimally interrupted anticoagulation (87.5 % vs 59.7 %, p < 0.001). Despite comparable rates of overall complications (5.7 % vs 3.5 %, p = 0.29), elderly patients had a higher incidence of stroke (2.3 % vs 0.3 %, p = 0.04). At 12 months, major adverse clinical events (4.5 % vs. 2.1 %, p = 0.12) and arrhythmia-free survival (70 % vs 74 %, p = 0.69) were comparable in both groups. None of the recurrence-free elderly patients were on antiarrhythmic drugs at the end of follow-up.
CONCLUSIONS: In this real-world cohort, the efficacy of PFA for AF was similar in elderly and younger patients. Despite comparable complication rates, a higher incidence of stroke was observed in the elderly.