CryoPVI for persistent AF in elderly patients (≥75 years) yielded higher symptomatic AF recurrence than in matched younger patients (44.9% vs 18.8%; HR 0.34; 95% CI 0.19-0.62; p=0.0004).
Observational (n=268)
No
Does age ≥75 years increase the risk of symptomatic atrial fibrillation recurrence after cryoballoon pulmonary vein isolation in patients with persistent atrial fibrillation?
Cryoballoon pulmonary vein isolation has limited efficacy in elderly patients (≥75 years) with persistent atrial fibrillation, who face an approximately threefold higher risk of symptomatic recurrence compared to matched younger patients.
Effect estimate: HR 0.34 (95% CI 0.19 to 0.62)
Absolute Event Rate: 44.9% vs 18.8%
p-value: p=0.0004
(1) Background: Cryoballoon pulmonary vein isolation (cryoPVI) is established for symptomatic paroxysmal atrial fibrillation (AF) treatment, but its value in persistent AF is less clear. In particular, limited data are available on its efficacy in elderly patients (≥75 years) with persistent AF. Age is an important modifier of AF progression and represents a risk-factor for AF recurrence. (2) Methods: Prospective, single-center observational study to evaluate the impact of age on efficacy and safety of cryoPVI in elderly patients. Primary efficacy endpoint was symptomatic AF recurrence after 90-day blanking period. Primary safety endpoints were death from any cause, procedure-associated complications or stroke/transient ischemic attack. Median follow-up was 17 months (range 3−24). (3) Results: We included 268 patients with persistent AF (94 ≥ 75 years of age). Multivariate Cox regression analysis identified age as the only independent factor influencing AF recurrence in the overall cohort (p = 0.006). To minimize confounding bias in efficacy and safety analysis of cryoPVI, we matched younger and elderly patients with respect to baseline characteristics. At 24 months, primary efficacy endpoint occurred in 13/69 patients <75 years and 31/69 patients ≥75 years of age (24 months Kaplan−Meier event-rate estimates, HR 0.34; 95% CI, 0.19 to 0.62; log-rank p = 0.0004). No differences were observed in the occurrence of safety end points. (4) Conclusions: Elderly (≥75 years) patients with persistent AF undergoing cryoPVI had an approximately threefold higher risk of symptomatic AF recurrence than matched younger patients. Accordingly, other treatment modalities may be evaluated in this population.
Boehmer et al. (Fri,) conducted a observational in Persistent atrial fibrillation (n=268). Cryoballoon pulmonary vein isolation (cryoPVI) in elderly patients (≥75 years) vs. Matched younger patients (<75 years) was evaluated on Symptomatic AF recurrence after 90-day blanking period (HR 0.34, 95% CI 0.19 to 0.62, p=0.0004). CryoPVI for persistent AF in elderly patients (≥75 years) yielded higher symptomatic AF recurrence than in matched younger patients (44.9% vs 18.8%; HR 0.34; 95% CI 0.19-0.62; p=0.0004).