Skip to main content
Log in

Procedural success, safety and patients satisfaction after second ablation of atrial fibrillation in the elderly: results from the German Ablation Registry

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Background

Aged patients are underrepresented in clinical trials on catheter ablation of atrial fibrillation (AF). In addition, results of outcomes after repeat ablation in the elderly are lacking. We report the results of first repeat AF ablation procedures of aged patients from a real-world multicenter prospective registry.

Methods

Patients undergoing second AF ablation included in the prospective, multicenter German Ablation Registry were divided in two groups (age > 70 years (group 1) and age ≤ 70 years (group 2)) and analyzed for procedural characteristics and clinical follow-up.

Results

738 patients were analyzed (108 patients in group 1, 630 patients in group 2). Significantly more aged patients had structural heart disease (56 patients (51.9%) vs. 203 patients (32.2%), p < 0.001). The majority of the patients underwent repeat pulmonary vein isolation (101 patients (93.5%) vs. 593 patients (94.1%), p = 0.98). More aged patients underwent ablation of left atrial linear lesions (78.1% vs. 57.3% of all linear lesions, p = 0.027). There was no difference in the occurrence of peri-procedural complications (7 patients (6.5%) vs. 24 patients (3.8%), p = 0.30). Recurrence of atrial arrhythmias was documented in 45/105 (42.9%) and 252/603 (41.8%) patients with available follow-up in groups 1 and 2 after a median of 447 (400; 532) and 473 (411; 544) days (p = 0.84). A comparable amount of patients were asymptomatic or reported symptom improvement after repeat ablation in both groups (80% (80/100) in group 1 and 77% (446/576) in group 2; p = 0.57).

Conclusion

Repeat ablation for AF in elderly patients can be performed with safety and efficacy comparable to younger patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al (2016) 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace 18(11):1609–1678

    Article  Google Scholar 

  2. Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J et al (2010) Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol 3(1):32–38. https://doi.org/10.1161/CIRCEP.109.859116(Epub 2009 Dec 7)

    Article  PubMed  Google Scholar 

  3. Metzner I, Wissner E, Tilz RR, Rillig A, Mathew S, Schmidt B et al (2016) Ablation of atrial fibrillation in patients ≥ 75 years: long-term clinical outcome and safety. Europace. 18(4):543–549. https://doi.org/10.1093/europace/euv229(Epub 2016 Jan 29)

    Article  PubMed  Google Scholar 

  4. Tscholl V, Lin T, Abdullah K, Lsharaf AKA, Bellmann B, Nagel P et al (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(5):772–777. https://doi.org/10.1093/europace/eux128

    Article  PubMed  Google Scholar 

  5. Moser JM, Willems S, Andresen D, Brachmann J, Eckardt L, Hoffmann E et al (2017) Complication rates of catheter ablation of atrial fibrillation in patients aged ≥ 75 years versus < 75 years-results from the German Ablation Registry. J Cardiovasc Electrophysiol 28(3):258–265. https://doi.org/10.1111/jce.13142(Epub 2017 Jan 14)

    Article  PubMed  Google Scholar 

  6. Ouyang F, Tilz R, Chun J, Schmidt B, Wissner E, Zerm T et al (2010) Long-term results of catheter ablation in paroxysmal atrial fibrillation: lessons from a 5-year follow-up. Circulation 122(23):2368–2377. https://doi.org/10.1161/CIRCULATIONAHA.110.946806

    Article  PubMed  Google Scholar 

  7. Tilz RR, Rillig A, Thum AM, Arya A, Wohlmuth P, Metzner A et al (2012) Catheter ablation of long-standing persistent atrial fibrillation: 5-year outcomes of the Hamburg Sequential Ablation Strategy. J Am Coll Cardiol 60(19):1921–1929. https://doi.org/10.1016/j.jacc.2012.04.060

    Article  PubMed  Google Scholar 

  8. Eitel C, Ince H, Brachmann J, Kuck KH, Willems S, Gerds-Li JH, Tebbenjohanns J, Richardt G, Hochadel M, Senges J, Tilz RR (2019) Atrial fibrillation ablation strategies and outcome in patients with heart failure: insights from the German ablation registry. Clin Res Cardiol. https://doi.org/10.1007/s00392-019-01411-3(Epub ahead of print)

    Article  PubMed  Google Scholar 

  9. Zado E, Callans DJ, Riley M, Hutchinson M, Garcia F, Bala R et al (2008) Long-term clinical efficacy and risk of catheter ablation for atrial fibrillation in the elderly. J Cardiovasc Electrophysiol 19(6):621–626. https://doi.org/10.1111/j.1540-8167.2008.01183.x(Epub 2008 May 5)

    Article  PubMed  Google Scholar 

  10. Corrado A, Patel D, Riedlbauchova L, Fahmy TS, Themistoclakis S, Bonso A et al (2008) Efficacy, safety, and outcome of atrial fibrillation ablation in septuagenarians. J Cardiovasc Electrophysiol 19(8):807–811. https://doi.org/10.1111/j.1540-8167.2008.01124.x(Epub 2008 Mar 21)

    Article  PubMed  Google Scholar 

  11. Leong-Sit P, Zado E, Callans DJ, Garcia F, Lin D, Dixit S et al (2010) Efficacy and risk of atrial fibrillation ablation before 45 years of age. Circ Arrhythm Electrophysiol 3(5):452–457. https://doi.org/10.1161/CIRCEP.110.938860(Epub 2010 Sep 21)

    Article  PubMed  Google Scholar 

  12. Kautzner J, Peichl P, Sramko M, Cihak R, Aldhoon B, Wichterle D (2017) Catheter ablation of atrial fibrillation in elderly population. J Geriatr Cardiol 14(9):563–568. https://doi.org/10.11909/j.issn.1671-5411.2017.09.008

    Article  PubMed  PubMed Central  Google Scholar 

  13. Abugattas JP, Iacopino S, Moran D, De Regibus V, Takarada K, Mugnai G et al (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(11):1798–1803. https://doi.org/10.1093/europace/eux023

    Article  PubMed  Google Scholar 

  14. Santangeli P, Di Biase L, Mohanty P, Burkhardt JD, Horton R, Bai R et al (2012) Catheter ablation of atrial fibrillation in octogenarians: safety and outcomes. J Cardiovasc Electrophysiol 23(7):687–693. https://doi.org/10.1111/j.1540-8167.2012.02293.x(Epub 2012 Apr 11)

    Article  PubMed  Google Scholar 

  15. Nademanee K, Amnueypol M, Lee F, Drew CM, Suwannasri W, Schwab MC et al (2015) Benefits and risks of catheter ablation in elderly patients with atrial fibrillation. Heart Rhythm 12:44–51

    Article  Google Scholar 

  16. Bunch TJ, May HT, Bair TL, Jacobs V, Crandall BG, Cutler M et al (2016) The impact of age on 5-year outcomes after atrial fibrillation catheter ablation. J Cardiovasc Electrophysiol 27(2):141–146. https://doi.org/10.1111/jce.12849

    Article  PubMed  Google Scholar 

  17. Akoum N, Mahnkopf C, Kholmovski EG, Brachmann J, Marrouche NF (2017) Age and sex differences in atrial fibrosis among patients with atrial fibrillation. Europace. https://doi.org/10.1093/europace/eux260(Epub ahead of print)

    Article  PubMed  Google Scholar 

  18. Blandino A, Toso E, Scaglione M, Anselmino M, Ferraris F, Sardi D et al (2013) Long-term efficacy and safety of two different rhythm control strategies in elderly patients with symptomatic persistent atrial fibrillation. J Cardiovasc Electrophysiol 24(7):731–738. https://doi.org/10.1111/jce.12126(Epub 2013 Apr 1)

    Article  PubMed  Google Scholar 

  19. Rillig A, Schmidt B, Di Biase L, Lin T, Scholz L, Heeger CH et al (2017) Manual versus robotic catheter ablation for the treatment of atrial fibrillation the man and machine trial. JACC: Clin Electrophysiol 3(8):875–883. https://doi.org/10.1016/j.jacep.2017.01.024

    Article  Google Scholar 

  20. Deshmukh A, Patel NJ, Pant S, Shah N, Chothani A, Mehta K et al (2013) In-hospital complications associated with catheter ablation of atrial fibrillation in the United States between 2000 and 2010: analysis of 93,801 procedures. Circulation 128:2104–2112

    Article  Google Scholar 

  21. Chun KR, Perrotta L, Bordignon S, Khalil J, Dugo D, Konstantinou A et al (2017) Complications in catheter ablation of atrial fibrillation in 3,000 consecutive procedures balloon versus radiofrequency current ablation. JACC Clin Electrophysiol 3(2):154–161. https://doi.org/10.1016/j.jacep.2016.07.002

    Article  PubMed  Google Scholar 

  22. Maurer T, Rottner L, Makimoto H, Reissmann B, Heeger CH, Lemes C, Fink T, Riedl J, Santoro F, Wohlmuth P, Volkmer M, Mathew S, Metzner A, Ouyang F, Kuck KH, Sohns C (2018) The best of two worlds? Pulmonary vein isolation using a novel radiofrequency ablation catheter incorporating contact force sensing technology and 56-hole porous tip irrigation. Clin Res Cardiol. https://doi.org/10.1007/s00392-018-1270-y(Epub ahead of print)

    Article  PubMed  Google Scholar 

  23. Heeger CH, Bellmann B, Fink T, Bohnen JE, Wissner E, Wohlmuth P, Rottner L, Sohns C, Tilz RR, Mathew S, Reissmann B, Lemeš C, Maurer T, Lüker J, Sultan A, Plenge T, Goldmann B, Ouyang F, Kuck KH, Metzner I, Metzner A, Steven D, Rillig A (2019) Efficacy and safety of cryoballoon ablation in the elderly: a multicenter study. Int J Cardiol 1(278):108–113. https://doi.org/10.1016/j.ijcard.2018.09.090(Epub 2018 Sep 27)

    Article  Google Scholar 

  24. Reissmann B, Budelmann T, Wissner E, Schlüter M, Heeger CH, Mathew S, Maurer T, Lemes C, Fink T, Rillig A, Santoro F, Riedl J, Ouyang F, Kuck KH, Metzner A (2018) Five-year clinical outcomes of visually guided laser balloon pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation. Clin Res Cardiol 107(5):405–412. https://doi.org/10.1007/s00392-017-1199-6

    Article  PubMed  Google Scholar 

  25. Bellmann B, Lin T, Ruppersberg P, Zettwitz M, Guttmann S, Tscholl V, Nagel P, Roser M, Landmesser U, Rillig A (2018) Identification of active atrial fibrillation sources and their discrimination from passive rotors using electrographical flow mapping. Clin Res Cardiol. https://doi.org/10.1007/s00392-018-1274-7(Epub ahead of print)

    Article  PubMed  Google Scholar 

Download references

Funding

This work was funded by an unrestricted grant from foundation ‘Stiftung Institut für Herzinfarktforschung Ludwigshafen’ (Ludwigshafen, Germany).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Thomas Fink.

Ethics declarations

Conflict of interest

Dr. Metzner received speaker’s honoraria from Medtronic. Dr. Willems received speaker honoraria from Abott, Boston Scientific, Boehringer Ingelheim, Bristol Myers Squibb, Bayer Vital, Acutus and study funding from Abott, Boston Scientific and Acutus. Dr Eckardt consulting fees/speaker honoraria from Bayer Health Care, Daiichi Sankyo, Pfizer, Bristol-Myers, Squibb, Boehringer Ingelheim, Johnson&Johnson, Medtronic, Boston Scientific, Abbott, Novartis and research support by the DFG the German Heart Foundation. Dr Brachmann received consulting fees/honoraria from Biotronik, Biosense Webster, Medtronic, Boston Scientific, and St. Jude Medical. Dr Rillig received travel grants/lecture fees from Biosense, Hansen Medical, Medtronic, EP Solutions and St. Jude Medical and participated at the Boston scientific EP-fellowship. The other authors report no conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 30 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fink, T., Metzner, A., Willems, S. et al. Procedural success, safety and patients satisfaction after second ablation of atrial fibrillation in the elderly: results from the German Ablation Registry. Clin Res Cardiol 108, 1354–1363 (2019). https://doi.org/10.1007/s00392-019-01471-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-019-01471-5

Keywords

Navigation