Safety and Efficacy of Second-Generation Cryoballoon Ablation in Patients Aged over 75 Years
DOI:
https://doi.org/10.59958/hsf.7483Keywords:
atrial fibrillation, second-generation cryoballoon, elderlyAbstract
Objective: The use of second-generation cryoballoon (CB2) for pulmonary vein isolation (PVI) in atrial fibrillation (AF) ablation therapy is common. This study aimed to compare the safety and efficacy of CB2 ablation for PVI in AF patients aged 75 years and older to those under 75 years old. Methods: A retrospective, observational study was conducted, including AF patients who underwent CB2 for PVI between January 2018 and December 2020 at our center. The patients were divided into two groups based on age: those aged 75 years and older (elderly group) and those under 75 years (control group). Procedural characteristics, complications, and one-year follow-up outcomes were compared between the two groups using Student's t-test or the chi-square test for univariate analysis. Results: A total of 156 AF patients treated with CB2 for PVI were included in the study, with 78 patients aged 75 years and older (elderly group, mean age = 78 years) and 78 patients aged under 75 years (control group, mean age = 66 years). The PVI procedure duration was 86.2 ± 25.8 minutes for the elderly group and 83.2 ± 20.8 minutes for the control group (p = 0.413). The elderly group showed a higher trend of complications (8/78, 10.3%) compared to the control group (2/78, 2.6%) (p = 0.049), although no serious complications were observed. One-year follow-up revealed that approximately 80% of patients in both groups did not experience AF recurrence (p = 0.656). Conclusion: CB2 ablation for PVI appears to be safe and effective in AF patients aged 75 years and older, with outcomes comparable to those in younger patients. However, special attention should be given to venous puncture in elderly patients.
References
Lippi G, Sanchis-Gomar F, Cervellin G. Global epidemiology of atrial fibrillation: An increasing epidemic and public health challenge. International Journal of Stroke: Official Journal of the International Stroke Society. 2021; 16: 217–221.
Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. European Heart Journal. 2021; 42: 373–498.
Jimenez-Candil J, Hernandez Hernandez J, Cruz Galban A, Blanco F, Moriñigo JL, Sanchez García M, et al. Clinical and economic outcomes of a systematic same-day discharge programme after pulmonary vein isolation: comparison between cryoballoon vs. radiofrequency ablation. Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 2023; 25: euad265.
Aryana A, Heist EK, Pitha JV, Fan R, Park JK. Pulmonary Vein Isolation Using Visually Guided Second-Generation Cryoballoon: A Multicenter, Prospective, Real-World Experience. The Journal of Innovations in Cardiac Rhythm Management. 2021; 12: 4600–4610.
Maltoni S, Negro A, Camerlingo MD, Pecoraro V, Sassone B, Biffi M, et al. Comparison of cryoballoon and radiofrequency ablation techniques for atrial fibrillation: a meta-analysis. Journal of Cardiovascular Electrophysiology. 2021; 32: 1365–1376.
Wazni OM, Dandamudi G, Sood N, Hoyt R, Tyler J, Durrani S, et al. Cryoballoon Ablation as Initial Therapy for Atrial Fibrillation. The New England Journal of Medicine. 2021; 384: 316–324.
Kuniss M, Pavlovic N, Velagic V, Hermida JS, Healey S, Arena G, et al. Cryoballoon ablation vs. antiarrhythmic drugs: first-line therapy for patients with paroxysmal atrial fibrillation. Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 2021; 23: 1033–1041.
Andrade JG, Wells GA, Deyell MW, Bennett M, Essebag V, Champagne J, et al. Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation. The New England Journal of Medicine. 2021; 384: 305–315.
Chun KRJ, Okumura Y, Scazzuso F, Frontera A, Magnani S. Safety and efficacy of cryoballoon ablation for the treatment of atrial fibrillation in elderly patients: A collaborative analysis. Pacing and Clinical Electrophysiology. 2021; 44: 360–368.
Wazni O, Moss J, Kuniss M, Andrade J, Chierchia GB, Mealing S, et al. An economic evaluation of first-line cryoballoon ablation vs antiarrhythmic drug therapy for the treatment of paroxysmal atrial fibrillation from a U.S. Medicare perspective. Heart Rhythm O2. 2023; 4: 528–537.
Shi LB, Rossvoll O, Tande P, Schuster P, Solheim E, Chen J. Cryoballoon vs. radiofrequency catheter ablation: insights from NOrwegian randomized study of PERSistent Atrial Fibrillation (NO-PERSAF study). Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 2022; 24: 226–233.
Boho A, Stancik J, Misikova S, Mrazek V, Hatala R. Long-term outcome after cryoballoon ablation of atrial fibrillation in elderly patients. Journal of Geriatric Cardiology. 2021; 18: 114–122.
Matsushita K, Arai K, Fukuzawa K, Imamura K, Okumura Y, Kofune T, et al. Efficacy and safety of cryoballoon ablation in elderly patients with atrial fibrillation: A multicenter study. Journal of Arrhythmia. 2020; 36: 917–922.
Kuck KH, Brugada J, Fürnkranz A, Metzner A, Ouyang F, Chun KRJ, et al. Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. The New England Journal of Medicine. 2016; 374: 2235–2245.
Kuniss M, Deisenhofer I, Schmidt B, Sticherling C, Ziackers M, Chun KRJ. Cryoballoon ablation for paroxysmal atrial fibrillation: 5-year outcome after single procedure and predictors of recurrence. Journal of Interventional Cardiac Electrophysiology. 2022; 65: 39–49.
Ruff CT, Giugliano RP, Braunwald E, Murphy SA, Brown K, Jarolim P, et al. Peripheral artery disease in patients with acute coronary syndromes. Circulation. 2014; 130: 1568–1576.
Chen S, Schmidt B, Yap SC. Cryoballoon or radiofrequency ablation for atrial fibrillation: an updated meta-analysis. Clinical Research in Cardiology. 2021; 110: 624–638.
Cheng X, Li X, He Y, Liu X, Qiu J, Zhou L. Cryoballoon vs radiofrequency ablation for paroxysmal atrial fibrillation: an updated meta-analysis of randomized and observational studies. Eurointervention. 2021; 16: 1076–1082.
Davis JJ, Svendsen JB, Konyn P, Dalili D, Peterson B, Rajan R, et al. Complications of arterial vascular access in interventional radiology. Current Problems in Diagnostic Radiology. 2021; 50: 536–549.
Looi KL, Arora J, Tavizón FP, Kumar N, Han FT, Lim PO, et al. Time to pulmonary vein isolation and atrial fibrillation recurrence following cryoballoon ablation: a systematic review and meta-analysis. Journal of the American Heart Association. 2021; 10: e021233.
Rottner L, Mathew S, Snipelisky D, Zaman J, Bowler D, Han J, et al. Feasibility, safety, and outcomes of achieving durable single-box pulmonary vein isolation in paroxysmal atrial fibrillation with cryoballoon ablation guided by real-time recordings. Heart Rhythm. 2022; 19: 1203–1211.
Yao Y, Sveniece S, Sedaghat G, Hunter H, Hussain N, Carr K, et al. Aging impairs atrial structure and function in humans. Cardiovascular Research. 2021; 117: 787–797.
Takahashi K, Okumura Y, Watanabe I, Kofune M, Kumagai K, Hiroki J, et al. Cryoablation time to encircling pulmonary veins is a predictor of atrioesophageal fistula after second-generation cryoballoon ablation. Journal of the American Heart Association. 2020; 9: e015972.
Gersh BJ, Hev EV, Chung MK, Brinker M, Kitzman DW, Rich MW, et al. Catheter ablation for atrial fibrillation in the elderly: a systematic review and meta-analysis. Journal of the American Heart Association. 2022; 11: e024267.
