Ablation of atrioventricular nodal reentrant tachycardia in the elderly: results from the German Ablation Registry
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Ablation of atrioventricular nodal reentrant tachycardia in the elderly: results from the German Ablation Registry. / Hoffmann, Boris A; Brachmann, Johannes; Andresen, Dietrich; Eckardt, Lars; Hoffmann, Ellen; Kuck, Karl-Heinz; Schumacher, Burghard; Spitzer, Stefan G; Schirdewahn, Petra; Tebbenjohanns, Jürgen; Horack, Martin; Senges, Jochen; Salukhe, Tushar V; Rostock, Thomas; Willems, Stephan.
in: HEART RHYTHM, Jahrgang 8, Nr. 7, 07.2011, S. 981-987.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Ablation of atrioventricular nodal reentrant tachycardia in the elderly: results from the German Ablation Registry
AU - Hoffmann, Boris A
AU - Brachmann, Johannes
AU - Andresen, Dietrich
AU - Eckardt, Lars
AU - Hoffmann, Ellen
AU - Kuck, Karl-Heinz
AU - Schumacher, Burghard
AU - Spitzer, Stefan G
AU - Schirdewahn, Petra
AU - Tebbenjohanns, Jürgen
AU - Horack, Martin
AU - Senges, Jochen
AU - Salukhe, Tushar V
AU - Rostock, Thomas
AU - Willems, Stephan
N1 - Copyright © 2011 Heart Rhythm Society. All rights reserved.
PY - 2011/7
Y1 - 2011/7
N2 - BACKGROUND: Catheter ablation (CA) is considered the treatment of choice for patients with atrioventricular nodal reentrant tachycardia (AVNRT). However, there is a tendency to avoid CA in the elderly because of a presumed increased risk of periprocedural atrioventricular (AV) nodal block.OBJECTIVE: The purpose of this prospective registry was to assess age-related differences in the efficacy and safety of CA within a large population with AVNRT.METHODS: A total of 3,234 consecutive patients from 48 German trial centers who underwent CA of AVNRT between March 2007 and May 2010 were enrolled in this study. The cohort was divided into three age groups: <50 years (group 1, n = 1,268 [39.2%]; median age = 40 [30.0-45.0] years, 74.1% women), 50-75 years old (group 2, n = 1,707 [52.8%]; 63.0 [58.0-69.0] years, 63.0% women), and > 75 years old (group 3, n = 259 [8.0%]; 79.0 [77.0-82.0] years, 50.6% women).RESULTS: CA was performed with radiofrequency current (RFC) in 97.7% and cryoablation technology in 2.3% of all cases. No differences were observed among the three groups with regard to primary CA success rate (98.7% vs. 98.8 % vs. 98.5%; P = .92) and overall procedure duration (75.0 minutes [50.0-105.0]; P = .93). Hemodynamically stable pericardial effusion occurred in five group 2 (0.3%) and two group 3 (0.8%) patients but in none of the group 1 (P <.05) patients. Complete AV block requiring permanent pacemaker implantation occurred in two patients in group 1 (0.2%) and six patients in group 2 (0.4%) but none in group 3 (P = 0.41). During a median follow-up period of 511.5 days (396.0-771.0), AVNRT recurrence occurred in 5.7% of all patients. Patients >75 years (group 3) had a significantly longer hospital stay (3.0 days [2.0-5.0]) compared with group 1 (2.0 days [1.0-2.0]) or group 2 (2.0 days [1.0-3.0]) patients (P <.0001).CONCLUSION: CA of AVNRT is highly effective and safe and does not pose an increased risk for complete AV block in patients over 75 years of age, despite a higher prevalence of structural heart disease. Antiarrhythmic drug therapy is often ineffective in this age group; thus, CA for AVNRT should be considered the preferred treatment even in elderly patients.
AB - BACKGROUND: Catheter ablation (CA) is considered the treatment of choice for patients with atrioventricular nodal reentrant tachycardia (AVNRT). However, there is a tendency to avoid CA in the elderly because of a presumed increased risk of periprocedural atrioventricular (AV) nodal block.OBJECTIVE: The purpose of this prospective registry was to assess age-related differences in the efficacy and safety of CA within a large population with AVNRT.METHODS: A total of 3,234 consecutive patients from 48 German trial centers who underwent CA of AVNRT between March 2007 and May 2010 were enrolled in this study. The cohort was divided into three age groups: <50 years (group 1, n = 1,268 [39.2%]; median age = 40 [30.0-45.0] years, 74.1% women), 50-75 years old (group 2, n = 1,707 [52.8%]; 63.0 [58.0-69.0] years, 63.0% women), and > 75 years old (group 3, n = 259 [8.0%]; 79.0 [77.0-82.0] years, 50.6% women).RESULTS: CA was performed with radiofrequency current (RFC) in 97.7% and cryoablation technology in 2.3% of all cases. No differences were observed among the three groups with regard to primary CA success rate (98.7% vs. 98.8 % vs. 98.5%; P = .92) and overall procedure duration (75.0 minutes [50.0-105.0]; P = .93). Hemodynamically stable pericardial effusion occurred in five group 2 (0.3%) and two group 3 (0.8%) patients but in none of the group 1 (P <.05) patients. Complete AV block requiring permanent pacemaker implantation occurred in two patients in group 1 (0.2%) and six patients in group 2 (0.4%) but none in group 3 (P = 0.41). During a median follow-up period of 511.5 days (396.0-771.0), AVNRT recurrence occurred in 5.7% of all patients. Patients >75 years (group 3) had a significantly longer hospital stay (3.0 days [2.0-5.0]) compared with group 1 (2.0 days [1.0-2.0]) or group 2 (2.0 days [1.0-3.0]) patients (P <.0001).CONCLUSION: CA of AVNRT is highly effective and safe and does not pose an increased risk for complete AV block in patients over 75 years of age, despite a higher prevalence of structural heart disease. Antiarrhythmic drug therapy is often ineffective in this age group; thus, CA for AVNRT should be considered the preferred treatment even in elderly patients.
KW - Adult
KW - Age Distribution
KW - Aged
KW - Aged, 80 and over
KW - Catheter Ablation/methods
KW - Cryosurgery/methods
KW - Female
KW - Follow-Up Studies
KW - Germany/epidemiology
KW - Heart Conduction System/physiopathology
KW - Heart Rate/physiology
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Prospective Studies
KW - Registries
KW - Tachycardia, Atrioventricular Nodal Reentry/epidemiology
KW - Treatment Outcome
U2 - 10.1016/j.hrthm.2011.02.008
DO - 10.1016/j.hrthm.2011.02.008
M3 - SCORING: Journal article
C2 - 21315834
VL - 8
SP - 981
EP - 987
JO - HEART RHYTHM
JF - HEART RHYTHM
SN - 1547-5271
IS - 7
ER -