Key result
Age >65 years was associated with a more anteriorly located successful ablation site for typical AVNRT, but procedure success (99% vs 99.4%) and complication rates (1% vs 0.6%) were similar to younger patients.
Why the study?
The clinical and electrophysiological characteristics of elderly patients with typical AVNRT and the safety and efficacy of slow-pathway RF ablation in this group were not well defined.
Is slow-pathway radiofrequency ablation safe and effective for typical AVNRT in patients older than 65 years compared to younger patients?
Cohort (n=1,290)
Yes
Is slow-pathway radiofrequency ablation safe and effective for typical AVNRT in patients older than 65 years compared to younger patients?
Absolute Event Rate: 99% vs 99.4%
p-value: p=NS
Slow-pathway radiofrequency ablation is a safe and effective first-line therapy for typical AVNRT in patients older than 65 years, despite requiring more RF pulses and longer procedure times.
Supports ablation consideration in elderly AVNRT despite longer procedures; leaves open randomized confirmation of equivalence.
BACKGROUND: The aim of this study was to retrospectively evaluate the clinical and electrophysiological characteristics of elderly patients with typical atrioventricular nodal reentrant tachycardia (AVNRT), and to assess the acute safety and efficacy of slow-pathway radiofrequency (RF) ablation in this specific group of patients. METHODS AND RESULTS: The present study retrospectively included a total of 1,290 patients receiving successful slow-pathway RF ablation for typical slow-fast AVNRT. Patients were divided into 2 groups: group I included 1,148 patients aged <65 years and group II included 142 patients aged >65 years. The required total procedure duration and total fluoroscopy exposure time were significantly higher in group II vs. group I (P=0.005 and P=0.0001, respectively). The number of RF pulses needed for a successful procedural end-point was significantly higher in group II than in group I (4.4 vs. 7.2, P=0.005). While the ratio of the anterior location near to the His-bundle region was significantly higher in group II, the ratio of posterior and midseptal locations were significantly higher in group I (P=0.0001). The overall procedure success rates were similar. There was no significant difference between the 2 groups in respect of the complications rates. CONCLUSIONS: This experience demonstrates that RF catheter ablation, targeting the slow pathway, could be considered as first-line therapy for typical AVNRT patients older than 65 years as well as younger patients, as it is very safe and effective in the acute period of treatment.
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Alihanoğlu et al. (2015) conducted a cohort in Typical slow-fast atrioventricular nodal reentrant tachycardia (AVNRT) (n=1,290). Age >65 years vs. Age <65 years was evaluated on Procedure success rate (p=NS). Age >65 years was associated with a more anteriorly located successful ablation site for typical AVNRT, but procedure success (99% vs 99.4%) and complication rates (1% vs 0.6%) were similar to younger patients.
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