Efficacy of cryoballoon ablation for atrial fibrillation in a geriatric population

Background Cryoballoon pulmonary vein isolation (cryoPVI) is well-established for paroxysmal atrial fibrillation (AF) but its value in persistent AF is less clear. In particular, its efficacy in cardiogeriatric patients (≥75 years) is unknown. Age represents an important modifier of AF progression and is a risk-factor for AF recurrence. Methods We conducted a prospective, single-center study to analyze efficacy and safety of cryoPVI in cardiogeriatric patients stratified according to AF entity. Maximum follow-up was 24 months. Efficacy endpoint was symptomatic AF relapse after 90-day blanking period. Results We included 668 patients. Of these 218 were ≥75 years old. Paroxysmal AF was present in 400 and persistent AF in 268 patients. By means of cox-regression analysis we found age as the only independent factor influencing AF recurrence in the overall cohort (P=0.034). This effect was carried by patients with persistent AF (P=0.006). At 24 months, the recurrence rate was highest in patients with persistent AF and age ≥75 years (57%; P=0.0004). Conclusion Cardiogeriatric patients with persistent AF undergoing cryoPVI had higher rates of AF recurrence compared to elderly patients with paroxysmal AF or younger patients. Against this background we assume, that pulmonary-vein dependent AF may be less frequently encountered among patients ≥75 years with persistent AF.