Catheter ablation of atrial fibrillation in the elderly: Where do we stand?

Catheter ablation has emerged as an important therapy for the management of drug refractory symptomatic paroxysmal and persistent atrial fibrillation (AF). Although the elderly account for the majority of patients with AF, limited data exists regarding the use of catheter ablation for elderly patients with AF. As AF ablation has become more widespread, ablation techniques have improved and the complication rate has decreased. As a result, referrals of elderly patients for catheter ablation of AF are on the rise. Two retrospective analyses have recently demonstrated that catheter ablation of AF in the elderly can safely be performed and results are comparable to a younger population with up to 80% or more of patients maintaining sinus rhythm at 12 months follow-up. We compared the results of 15 consecutive patients ≥ 70 years old with symptomatic paroxysmal atrial fibrillation who underwent catheter ablation of AF at our institution to 45 randomly sampled younger patients. The primary endpoint of our study, presence of sinus rhythm in the absence of symptoms at 12 months follow-up, was present in 60% of elderly patients and 80% of younger patients (p = 0.17). There was no statistically significant difference in complication rate between the younger and elderly patients. In this article we present the results of our study and review the published literature to date regarding the clinical efficacy and safety of catheter ablation for AF in elderly patients with paroxysmal and persistent atrial fibrillation

Comparison of outcomes in patients undergoing defibrillation threshold testing at the time of implantable cardioverter-defibrillator implantation versus no defibrillation threshold testing

Background: Inability to perform defibrillation threshold (DFT) testing during implantable cardioverter defibrillator (ICD) implantation due to co-morbidities may influence long-term survival. Methods: Retrospective review at The University of Michigan (1999-2004) identified 55 patients undergoing ICD implantation without DFT testing (“No-DFT group”). A randomly selected sample of patients (n = 57) undergoing standard DFT testing (“DFT group”) was compared in terms of appropriate shocks, clinical shock efficacy and all-cause mortality. Results: DFT testing was withheld due to hypotension, atrial fibrillation with inability to exclude left atrial thrombus, left ventricular thrombus, CHF and/or ischemia. The No-DFT group had a similar appropriate shock rate, but lower total survival (69.1% vs. 91.2%, p = 0.004) than the DFT group. The No-DFT group had a higher incidence of ventricular fibrillation (VF) episodes (9.1% vs. 3.1%, p = 0.037), and deaths attributable to VF (3 of 17 deaths vs. 0 of 5 deaths) compared to the DFT group. Multivariate analysis found a trend toward increased risk of death in the No-DFT group (HR 3.18, 95% CI 0.82-12.41, p = 0.095) after adjusting for baseline differences in gender distribution, NYHA class and prior CABG. Conclusions: In summary, overall mortality was higher in the No-DFT group. More deaths attributable to VF occurred in the No-DFT group. Thus, DFT testing should therefore remain the standard of care. Nevertheless, ICD therapy should not be withheld in patients who meet appropriate implant criteria simply on the basis of clinical scenarios that preclude routine DFT testing. (Cardiol J 2007; 14: 463-469

Pulmonary Vein Isolation for Vagotonic, Adrenergic, and Random Episodes of Paroxysmal Atrial Fibrillation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75410/1/j.1540-8167.2004.03432.x.pd