Abstract
BACKGROUND: Data on atrial fibrillation (AF) ablation using high-power short-duration (HPSD) ablation in patients over 80 years are lacking. OBJECTIVE: This study aimed to compare the safety and efficacy of paroxysmal and persistent AF ablation using an HPSD (60-90 W/4-8 sec) vs conventional ablation (30-40 W/30 sec) in a propensity score-matched cohort of patients older than 80 years. METHODS: Overall, 232 consecutive patients aged over 80 years undergoing AF ablation were included. Propensity score matching revealed 102 pairs for maximizing comparability. A post-ablation 42-day blanking period was applied. Major complications were defined as those requiring intervention or causing sequels within 30 days following catheter ablation. RESULTS: Procedural duration (132.7 ± 45.7 vs 155.4 ± 59.7 min; P = .0062) and x-ray exposure (dose area product 248.9 ± 313.6 vs 544.9 ± 704.7 cGycm(2); P = .0002) were significantly reduced in the HPSD group. Safety end points showed no significant differences (4/102 vs 7/102; P = .54). Freedom from any arrhythmia was not different between the groups including a follow-up of 22.5 ± 22.7 months (hazard ratio, 0.71; 95% confidence interval, 0.48-1.06 for the HPSD approach). After 1.52 ± 0.79 procedures, 80.4 % of all patients remained in sinus rhythm with a lower number of repeat procedures in the HPSD group (1.38 ± 0.65 vs 1.65 ± 0.90; P = .038). CONCLUSIONS: In very old patients (>80 years), AF ablation using an HPSD approach can be performed safely and effectively with a reduction of procedure duration, x-ray exposure, and fewer repeat ablations compared to a conventional approach. Long-term ablation results are promising with both approaches.