Key result
Invasive electrophysiology procedures in patients aged ≥80 carry similar major complications but higher minor risks.
Why the study?
Catheter ablation is established for cardiac arrhythmias, but data on invasive electrophysiological procedures in aged patients are lacking.
Do invasive electrophysiological procedures increase the risk of periprocedural complications and intrahospital mortality in patients aged ≥ 80 years compared to younger patients?
Cohort (n=966)
No
Do invasive electrophysiological procedures increase the risk of periprocedural complications and intrahospital mortality in patients aged ≥ 80 years compared to younger patients?
Invasive electrophysiological procedures in patients aged 80 and older are generally feasible but require careful patient selection due to increased minor complications and trends toward higher major complications and mortality compared to younger patients.
May warrant caution for EP procedures in octogenarians; leaves open whether age independently predicts major complications.
BACKGROUND: Catheter ablation is an established treatment for cardiac arrhythmia. There is a lack of data on invasive electrophysiological (EP) procedures in aged patients. METHODS: Consecutive patients ≥ 80 years who underwent catheter ablation or left atrial appendage closure procedures between January 2005 and December 2017 in a high-volume center were retrospectively studied and compared to a matched control group of individuals < 80 years of age. RESULTS: The aged group consisted of 486 patients who underwent 566 procedures at a mean age of 82.7 ± 2.5 years (range 80-95 years). A cohort of 480 patients aged < 80 years (mean age 64.1 ± 13.3 years) with 566 procedures served as a control group. Performed procedures were atrial arrhythmia ablation including atrial fibrillation treatment (n = 366, 64.7%), cavotricuspid isthmus ablation (n = 139, 24.6%), ablation of ventricular arrhythmias (n = 57, 10.1%), and left atrial appendage closure (n = 12, 2.1%). There were numerically more procedures with major complications after treatment of elderly patients (32 [5.7%] vs. 21 [3.5%] procedures, p = 0.12), as well as numerically more procedures accompanied by intrahospital deaths (6 [1.1%] vs. 1 [0.2%] procedure, p = 0.12). The rate of minor complications was significantly higher in aged patients as compared to younger controls (31 [5.1%] vs. 17 [20%] procedures, p = 0.039). CONCLUSION: Invasive EP procedures in octogenarians and nonagenarians are feasible, however a significantly higher incidence of minor periprocedural complications and a trend toward more severe complications and intrahospital fatalities were observed compared to younger patients. These findings support an individual risk-benefit assessment for elderly individuals before invasive EP treatments are conducted.
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Sciacca et al. (2025) conducted a cohort in Cardiac arrhythmias requiring invasive electrophysiological procedures (n=966). Age ≥ 80 years vs. Age < 80 years was evaluated on Periprocedural major complications (p=0.12). Invasive electrophysiological procedures in aged patients (≥80 years) showed numerically more major complications (5.7% vs. 3.5%, p=0.12) and significantly more minor complications compared to younger controls.
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