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CLINICAL STUDIES

Efficacy and safety of catheter ablation in octogenarians

Erica S. Zado, PA-C^{* b}, David J. Callans, MD, FACC^{* b}, Charles D. Gottlieb, MD, FACC^{* b}, Steven P. Kutalek, MD, FACC^{* b}, Sabrina L. Wilbur, MD, FACC^{* b}, Fania L. Samuels, MD^{* b}, Scott E. Hessen, MD, FACC^{* b}, Colin M. Movsowitz, MD, FACC^{* b}, John M. Fontaine, MD, FACC^{* b}, Stephen E. Kimmel, MD, MS, FACC^{* b} and Francis E. Marchlinski, MD, FACC^{* b}

^* Electrophysiology Section of MCP Hahnemann University, Philadelphia, Pennsylvania, USA
^b the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA,zcnyx
Department of Biostatistics and Epidemiology at the University of Pennsylvania Health Systems, Philadelphia, Pennsylvania, USA

Manuscript received July 23, 1998; revised manuscript received August 17, 1999, accepted October 18, 1999.

Reprint requests and correspondence: Dr. Francis Marchlinski, Hospital of the University of Pennsylvania, 3400 Spruce Street, 9 Founders, Philadelphia, Pennsylvania 19104
Marchlin{at}mail.med.upenn.edu

OBJECTIVES

To determine whether catheter ablation is safe and effective in patients over the age of 80.

BACKGROUND

There is a tendency to withhold invasive therapy in the elderly until it has been proven safe and effective.

METHODS

Over a two-year period from February 1, 1996 to February 1, 1998, 695 consecutive patients underwent 744 catheter ablation procedures of supraventricular and ventricular arrhythmias. These patients were divided into three groups based on age: 80 years, 60 to 79 years and <60 years. Acute ablation success, using standard criteria and complication rates for these three groups were determined.

RESULTS

There were 37 patients 80 years, 275 patients 60 to 79 years and 383 patients <60 years old. The overall acute ablation success rate for the entire group was 95% with no difference in rates among the three groups (97%, 80 years; 94%, 60–79 years; 95%, <60 years). The percentage of patients undergoing His bundle ablation was greatest in the 80-year-old group (43% vs. 19% vs. 2%, p < 0.01), and the percentage of patients undergoing accessory pathway ablation was greatest in the <60-year-old patients (0% vs. 4% vs. 25%, p < 0.01). The overall complication rate for the entire group was 2.6%, and there was only one major/life-threatening complication. There was no difference in complication rates among the groups (0%, 80 years; 2.2%, 60 to 79 years; 3.1%, <60 years). Based on the sample size, the 95% confidence interval is 0% to 7.8% for an adverse event in the octogenarian.

CONCLUSIONS

Catheter ablative therapy for the arrhythmias attempted in the very elderly appears to be effective with low risk. Ablation results appear to be comparable with those noted in younger patients.

Abbreviations and Acronyms   AP = accessory pathway   AV = atrioventricular   AVNRT = atrioventricular nodal reentrant tachycardia   CS = coronary sinus   IVC-TV = inferior vena cava tricuspid valve   VT = ventricular tachycardia

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