Persistent Atrial Fibrillation in Elderly Patients: Limited Efficacy of Pulmonary Vein Isolation

(1) Background: Cryoballoon pulmonary vein isolation (cryoPVI) is established for symptomatic paroxysmal atrial fibrillation (AF) treatment, but its value in persistent AF is less clear. In particular, limited data are available on its efficacy in elderly patients (≥75 years) with persistent AF. Age is an important modifier of AF progression and represents a risk-factor for AF recurrence. (2) Methods: Prospective, single-center observational study to evaluate the impact of age on efficacy and safety of cryoPVI in elderly patients. Primary efficacy endpoint was symptomatic AF recurrence after 90-day blanking period. Primary safety endpoints were death from any cause, procedure-associated complications or stroke/transient ischemic attack. Median follow-up was 17 months (range 3–24). (3) Results: We included 268 patients with persistent AF (94 ≥ 75 years of age). Multivariate Cox regression analysis identified age as the only independent factor influencing AF recurrence in the overall cohort (p = 0.006). To minimize confounding bias in efficacy and safety analysis of cryoPVI, we matched younger and elderly patients with respect to baseline characteristics. At 24 months, primary efficacy endpoint occurred in 13/69 patients p = 0.0004). No differences were observed in the occurrence of safety end points. (4) Conclusions: Elderly (≥75 years) patients with persistent AF undergoing cryoPVI had an approximately threefold higher risk of symptomatic AF recurrence than matched younger patients. Accordingly, other treatment modalities may be evaluated in this population

Larval growth history determines juvenile growth and survival in a tropical marine fish

Processes that occur around the transition between larval and juvenile life-stages can have a major effect on the population dynamics of organisms with complex life cycles.\ud We explore the roles of larval history and selective post-settlement mortality in determining the growth and survival of newly-settled individuals of the damselfish,\ud Pomacentrus amboinensis (Pomacentridae). Specifically, we determine whether the direction and intensity of selection on the recruits differs among various size-classes of\ud predators. A mark-recapture study showed that individuals who survived 9 or more days were significantly larger at settlement than those that died within the first day\ud (12.3 vs 11.9 mm SL), when mortality was highest (25% d1). Censuses revealed that the species and size composition of piscivores differed markedly between two reef habitats where P. amboinensis was common. A cage experiment, conducted in both habitats, manipulated the sizes of predators that could access newly settled P. amboinensis to determine whether the resulting mortality of the recently settled fish was influenced by larval growth history or size at settlement. Ten days after the start of the experiment individuals that grew slowly in the second half of their larval life had been lost from most of the experimental treatments. Small fish were also selectively lost from the coarse-mesh cage on the reef base. Significant positive relationships between pre- and post-settlement growth rates were found in both habitats for the fine mesh cages, cage controls and open patch reefs. This relationship was reversed in the coarse\ud mesh cages in both habitats. This growth compensation was facilitated through the action of a particular size range of predators, whose impact was disrupted or masked in\ud the open treatments by the action of a diverse predator pool. The present study underscores the complexity of the processes that influence the early post-transition growth and survival in organisms with complex life-histories