Impact of Age on the Outcome of Pulmonary Vein Isolation for Atrial Fibrillation Using Circular Mapping Technique and Cooled-Tip Ablation Catheter:

A Retrospective Analysis

Authors

  • MANDEEP BHARGAVA M.D.,

    1. Center for Atrial Fibrillation, Section of Pacing and Electrophysiology, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
    Search for more papers by this author
  • NASSIR F. MARROUCHE M.D.,

    1. Center for Atrial Fibrillation, Section of Pacing and Electrophysiology, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
    Search for more papers by this author
  • DAVID O. MARTIN M.D.,

    1. Center for Atrial Fibrillation, Section of Pacing and Electrophysiology, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
    Search for more papers by this author
  • ROBERT A. SCHWEIKERT M.D.,

    1. Center for Atrial Fibrillation, Section of Pacing and Electrophysiology, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
    Search for more papers by this author
  • WALID SALIBA M.D.,

    1. Center for Atrial Fibrillation, Section of Pacing and Electrophysiology, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
    Search for more papers by this author
  • EDUARDO B. SAAD M.D.,

    1. Center for Atrial Fibrillation, Section of Pacing and Electrophysiology, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
    Search for more papers by this author
  • DIANNA BASH R.N,

    1. Center for Atrial Fibrillation, Section of Pacing and Electrophysiology, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
    Search for more papers by this author
  • MICHELLE WILLIAMS-ANDREWS R.N,

    1. Center for Atrial Fibrillation, Section of Pacing and Electrophysiology, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
    Search for more papers by this author
  • ANTONIO ROSSILLO M.D.,

    1. Center for Atrial Fibrillation, Section of Pacing and Electrophysiology, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
    Search for more papers by this author
  • DEMET ERCIYES M.D.,

    1. Center for Atrial Fibrillation, Section of Pacing and Electrophysiology, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
    Search for more papers by this author
  • YAARIV KHAYKIN M.D.,

    1. Center for Atrial Fibrillation, Section of Pacing and Electrophysiology, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
    Search for more papers by this author
  • J. DAVID BURKHARDT M.D.,

    1. Center for Atrial Fibrillation, Section of Pacing and Electrophysiology, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
    Search for more papers by this author
  • GEORGE JOSEPH M.D.,

    1. Center for Atrial Fibrillation, Section of Pacing and Electrophysiology, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
    Search for more papers by this author
  • PATRICK J. TCHOU M.D.,

    1. Center for Atrial Fibrillation, Section of Pacing and Electrophysiology, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
    Search for more papers by this author
  • ANDREA NATALE M.D.

    1. Center for Atrial Fibrillation, Section of Pacing and Electrophysiology, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
    Search for more papers by this author

  • Preliminary results were presented in abstract form at the 2001 American Heart Association meetings, Atlanta, Georgia.

  • Manuscript received 5 June 2003; Accepted for publication 3 September 2003.

Address for correspondence: Andrea Natale, M.D., Department of Cardiology, Desk F15, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195. Fax: 216-444-4428; E-mail: natalea@ccf.org

Abstract

Introduction: A retrospective analysis was performed to define the impact of age on the outcomes and complications in patients undergoing pulmonary vein isolation (PVI). PVI is an evolving technique for the management of atrial fibrillation (AF). The impact of age on the risks, outcomes, and complications of PVI has not been well defined.

Methods and Results: A total of 323 patients (259 men and 64 women; age 18–79 years) underwent PVI for treatment of drug-refractory symptomatic AF. An ostial isolation of the pulmonary veins was done using a cooled-tip ablation catheter guided by circular mapping. The patients were divided into three groups based on age (group I: <50 years, group II: 51–60 years, group III: >60 years) and the results were compared. There were 106 patients in group I, 114 patients in group II, and 103 patients in group III (mean age 41.3 ± 7.8 years, 55.4 ± 2.75 years, and 66.6 ± 4.18 years, respectively) who underwent PVI for paroxysmal (53.8%), persistent (10.8%), or permanent (35.3%) AF. Baseline characteristics were similar except for a higher prevalence of hypertension and/or structural heart disease in groups II and III (58% and 63% vs 33% in group I, respectively). The procedural variables were similar in all age groups. The overall risk of complications was similar in the three groups, except that the risk of stroke was significantly higher in patients >60 years of age (3% vs 0%; P < 0.05). The recurrence rates of AF were similar in the three age groups (15.1%, 16.7%, and 18.4%, respectively; P > 0.05). The risk of severe pulmonary vein stenosis (1.8%, 2.6%, and 0.9%, respectively) was low and did not vary with age.

Conclusion: PVI is a safe and effective treatment for patients with drug-refractory symptomatic AF, and its benefits extend to all age groups. The risk of procedural complications, especially thromboembolic events, appears to be higher in the elderly age group. This observation needs to be considered while assessing potential candidates for the procedure. (J Cardiovasc Electrophysiol, Vol. 15, pp. 8-13, January 2004)

Ancillary