Radiofrequency ablation of the pulmonary vein ostia in elderly patients with atrial fibrillation

BACKGROUND: Restoration and maintenance of sinus rhythm is one of the most important aspects of managing patients with atrial fibrillation. The greatest effectiveness is achieved when this intervention is performed in young patients without comorbidities and in patients with paroxysmal atrial fibrillation. The appropriateness of performing radiofrequency ablation of the pulmonary vein ostia in elderly patients with atrial fibrillation remains a subject of debate.

AIM: to study the immediate and long-term results of catheter ablation in elderly patients with AF.

MATERIALS AND METHODS: The study group consisted of 88 patients aged 75–88 years who underwent RFA of the pulmonary vein ostia. The technique used was classical, with femoral puncture access, and irrigated ablation catheter. Data analyzed included ECG parameters, incidence of systemic thromboembolic complications, functional class of chronic heart failure according to NYHA, subjective state post-procedure, occurrence of atrial fibrillation recurrences, and the impact of baseline clinical factors on disease recurrence.

RESULTS: In 80 patients (90.9%), atrial fibrillation did not recur during their hospital stay after radiofrequency ablation of the pulmonary vein ostia. In the long term (min 1.5, max 3.1 years), a cross-sectional observational study was conducted on 37 patients. Adherence to oral anticoagulants was 97.6%. No systemic thromboembolic events were recorded among the patients available for contact. Atrial fibrillation recurrences troubled 67.6% of patients after radiofrequency ablation. The main predictors of atrial fibrillation recurrence in elderly patients were the presence of hypertension (p=0.03) and baseline left atrial enlargement (p=0.001). Despite the high recurrence rate, there was a significant reduction in the functional class of chronic heart failure following radiofrequency ablation of the pulmonary vein ostia (p=0.009).

CONCLUSIONS: Strict selection is required for performing catheter ablation in patients with atrial fibrillation older than 75 years. Significant left atrial enlargement and uncontrolled hypertension are major limitations for performing RFA of the pulmonary vein ostia in the elderly. The procedure demonstrates significant effectiveness in terms of reducing chronic heart failure functional class in patients over 75 years old, despite the high recurrence rates in the long term.