Contemporary catheter ablation of arrhythmias in geriatric patients: patient characteristics, distribution of arrhythmias, and outcome

AIMS: Catheter ablation is a treatment of first choice for many arrhythmias. Data in geriatric patients are still limited, mostly focusing on single arrhythmia types. The aim of the study was to investigate characteristics of contemporary ablation therapy in the very elderly, focusing on patient characteristics, arrhythmia spectrum, and outcome in a large cohort. METHODS AND RESULTS: We studied 131 consecutive patients aged 80 and older (mean age 83 +/- 3) undergoing ablation for any indication from 1998 until 2004. Sixty-eight patients (52%) had structural heart disease. Most common indications were typical atrial flutter (54%), atrioventricular nodal re-entrant tachycardia (AVNRT) (22%), and atrial fibrillation (AF) (18%). Patients with structural heart disease had more often atrial flutter (72 vs. 35%, P < 0.001) and less AVNRT (7 vs. 38%, P < 0.001) than those without structural heart disease. In almost all patients with AF, ventricular rate control was achieved by elimination of atrioventricular conduction and pacemaker implantation. Success rate exceeded 97% for all ablation types. There was one major complication (0.8%), a stroke after isthmus ablation. CONCLUSION: Almost half of the very elderly patients undergoing ablation have structural heart disease. Indications have changed significantly in recent years, typical atrial flutter is nowadays the predominant indication. The arrhythmia spectrum differs significantly between patients with and without structural heart disease. Regardless of the presence or absence of structural heart disease, success is excellent. Catheter ablation is an excellent therapy option for geriatric patients with arrhythmias.