Isolation of the Pulmonary Veins Ostia in Elderly and Geriatric Patients

This article presents the results of radiofrequency ablation of atrial fibrillation in elderly and geriatric patients. A total of 151 patients were included in the study. The subjects were divided into two groups: Group 1 consisted of patients aged 65 to 75 years, while Group 2 included those over 75 years of age. The follow-up period lasted for 1 year.

BACKGROUND. According to the literature, the prevalence of atrial fibrillation (AF) in the population ranges from 1 % to 2 %. This frequency increases with age, from less than 0.5 % in individuals aged 40 to 50 years to 5 % to 15 % in those aged 80 years [1–8]. Considering the increase in life expectancy, we can also expect a rise in the number of elderly and senile patients with atrial fibrillation. [9–11, 22]. Given that pulmonary vein ostia isolation is the gold standard for treating this condition, there is a need for studies that reflect the profile of efficacy and safety of radiofrequency ablation for atrial fibrillation in patients within these age groups. [12–21].

OBJECTIVE. To investigate the efficacy and safety of pulmonary vein ostia isolation in elderly and geriatric patients.

MATERIALS AND METHODS. The study is retrospective in nature. It was conducted in 2022–2023 at the Pirogov University Russian Gerontological Scientific Clinical Center. The first group included 104 patients aged up to 75 years (42 men, 62 women, with a mean age of 62 years and a mean disease duration of 5.2 years). The second group comprised 47 patients over 75 years old (14 men, 33 women, with a mean age of 78 years and a mean disease duration of 8.2 years). Inclusion criteria for the study were: age over 18 years, indications for radiofrequency ablation of atrial fibrillation, symptomatic atrial fibrillation, and anticoagulant therapy for more than four weeks prior to the procedure. Exclusion criteria included any contraindications to surgical intervention. The primary efficacy endpoint was the absence of recorded atrial fibrillation lasting more than 30 seconds during the blind period (2 months). The secondary efficacy endpoint was the absence of atrial tachycardia, atypical atrial flutter, typical atrial flutter, atrial fibrillation after the blind period, death, stroke, or transient ischemic attacks (TIA). The assessment of the results was conducted using Holter monitoring and during clinic visits at 3, 6, and 12 months after the procedure. A significant portion of patients had paroxysmal atrial fibrillation, with 79 individuals in the first group (76 %) and 34 individuals in the second group (72 %). The most common comorbidity among patients in the first group was hypertension (97 patients, 93.27 %), followed by dyslipidemia (64 patients, 61.54 %). Chronic cerebral ischemia was observed in 48 patients (46.15 %), chronic heart failure in 46 (44.23 %), chronic kidney disease in 24 (23.07 %), diabetes mellitus in 14 (13.46 %), ischemic heart disease in 10 (9.62 %), and a history of stroke or TIA in 6 (5.77 %). Chronic obstructive pulmonary disease (COPD) was present in 5 patients (4.81 %), and post-infarction cardiosclerosis (PICS) in 4 (3.85 %). Implantation of a pacemaker due to sick sinus syndrome or atrioventricular block was performed prior to the study in 4 patients (3.85 %).

In the group over 75 years of age, hypertension and dyslipidemia were present in 43 patients (91.45 %), chronic cerebral ischemia in 32 (68.09 %), heart failure in 35 (74.45 %), kidney disease in 9 (19.15 %), diabetes mellitus in 9 (19.15 %), ischemic heart disease in 8 (17.02 %), and a history of stroke or TIA in 9 (19.15 %). COPD was diagnosed in 5 patients (10.64 %), and PICS in 3 (6.38 %). Pacemaker implantation was performed in 7 patients (14.89 %).

All patients underwent atrial isolation of the pulmonary vein orifices using a three-dimensional navigation system.

RESULTS. The duration of the surgery in the first and second groups was comparable: (56 ± 14) minutes and (49 ± 13) minutes (p < 0.05). Criteria for the isolation of the pulmonary vein ostia were achieved in all patients. No serious complications, such as hemopericardium, ischemic stroke, or atrial-esophageal fistula, were recorded. The efficacy during the blind period was 78.8 % (82 patients) in the first group and 81.4 % (34 patients) in the second group, with χ² = 1.648, p = 0.194. The efficacy after 1 year of follow-up was 75.9 % (79 patients) in the first group and 76.7 % (33 patients) in the second group, with χ² = 0.003, p < 0.05.

CONCLUSION. Radiofrequency ablation for atrial fibrillation in elderly and senile patients demonstrates a high profile of efficacy and safety. However, further studies are necessary to confirm this conclusion.

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