Pulmonary vein isolation with pulsed field ablation was used across all ages with similar complication rates, but AF recurrence was significantly higher in patients ≥75 years (p=0.011).
Does chronological and biological age impact procedural outcomes and atrial fibrillation recurrence in patients undergoing first-time pulmonary vein isolation?
Chronological age <75 years and lower biological age measured by an AGE-Reader are associated with fewer atrial fibrillation recurrences after first-time pulmonary vein isolation.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Atrial fibrillation (AF) is the most common arrhythmia with a rising age-related incidence. The complication rates and outcomes of pulmonary vein isolation (PVI) among the elderly remain elusive, are not covered by guideline recommendations and are subject of ongoing discussions. Objective of this single center analysis was to evaluate the impact of chronological (chrono-) age on choice of ablation modalities pulsed field ablation (PFA), radiofrequency (RF) or cryoballoon (CBA) and their relation to procedural outcome. Additionally, we assessed biological (bio-) age using a novel AGE-reader and compared it with chrono-age in relation to PVI outcomes. Advanced Glycation Endproducts (AGEs) are central in cardiovascular disease and diabetes, accumulating faster in patients with diabetes, renal failure, and cardiovascular disease. Methods We retrospectively analyzed 354 patients who underwent first-time PVI. Baseline characteristics were recorded, and bio-age was estimated using a non-invasive AGE-Reader, which measures glycated proteins in skin tissue through autofluorescence. PFA was performed using two systems. We analyzed PVI modality, procedural parameters, and 30-day complications. Ablation outcomes were assessed after a mean follow-up of 208 ±180 days and correlated with chrono- and bio-age of the patients. Results Our analysis showed consistently the most frequent and similar use of PFA in all age groups, while the percentage of RF and CBA procedures declined with higher age (figure A). We observed that procedural parameters did not differ significantly between age groups (figure B). Nevertheless, when stratifying patients according to the ablation modality there were significant differences (p0.05) between the three modalities for procedure and fluoroscopy times, radiation dosage and contrast agent, respectively (figure C). No differences were observed regarding complications, when stratified for age or ablation modality. However, younger patients (75a) had statistically significant fewer recurrences of atrial fibrillation (p=0.011) (figure D). We calculated a ratio of measured (biological) age to expected bio-age and showed a lower benefit of a higher age ratio (=higher bio-age) with respect to AF recurrences (figure E). Conclusion PVI procedures in the elderly population present unique challenges and considerations that need tailored approaches to treatment. In our center most 1st PVI procedures were already performed with PFA independent from age throughout all groups with favorable outcomes. In this context the AGE-Reader might provide a comprehensive framework in the future for predicting procedural success by determining the "real" biological age. Nevertheless, further data and larger studies are required to confirm this hypothesis.
Falagkari et al. (Sat,) reported a other. Pulmonary vein isolation with pulsed field ablation was used across all ages with similar complication rates, but AF recurrence was significantly higher in patients ≥75 years (p=0.011).
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