Propensity-matched comparison of cryoballoon and radiofrequency ablation for atrial fibrillation in elderly patients.

BACKGROUND

Pulmonary vein isolation (PVI) with a cryoballoon (CB) is an effective treatment for atrial fibrillation (AF). The efficacy of CB PVI for elderly patients with AF remains unclear.

OBJECTIVE

We aimed to analyze the clinical outcomes of CB ablation compared with radiofrequency (RF) ablation in elderly patients with AF.

METHODS

This was a single-center retrospective study of 305 patients older than 75 years with paroxysmal and persistent AF who underwent PVI between January 2012 and August 2017. Patients were matched according to propensity scores in a logistic regression model. The end point of this study was AF/atrial tachycardia recurrence at 12-month follow-up.

RESULTS

In total, 198 patients (99 matched pairs) were analyzed. The ratio of paroxysmal AF was 83%, and the mean age was 78 ± 2 years. The mean procedure time was significantly lower in the CB group (134 ± 62 minutes vs 190 ± 51 minutes; P < .001). There was no significant difference between the groups in terms of success rate at 12 months after the procedure (CB 80.5% vs RF 79.4%; P = .72) or incidence of complications (CB 12% vs RF 16%; P = .80). Kaplan-Meier estimates revealed no significant difference between clinical outcomes after PVI with a CB or RF for elderly patients with non-pulmonary vein foci that were all successfully ablated (CB 68.8% vs RF 68.4% at 12 months; P = .835).

CONCLUSION

The efficacy of PVI with a CB might be comparable to that of PVI with RF in AF patients older than 75 years and involve a shorter procedure time.