Abstract
BACKGROUND: Cryoballoon ablation (CBA) achieves satisfactory outcomes in patients with atrial fibrillation (AF). However, its feasibility in older patients with heart failure (HF) remains unclear. OBJECTIVES: This study examined the efficacy and prognosis of CBA in older patients with HF. METHODS: Among 3,655 patients undergoing CBA at 17 institutions, 549 patients (185 with ≥75 years [older], and 364 with <75 years [younger]) diagnosed with HF were analyzed. Recurrence, mortality, and HF hospitalization after CBA between the older and younger groups were compared using Kaplan-Meier curves and Simon-Makuch analyses. Changes in left ventricular ejection fraction (LVEF) on echocardiography and B-type natriuretic peptide levels were evaluated using linear regression analysis. Major procedural complications included stroke, cardiac tamponade, phrenic nerve injury, prolonged hospitalization, and others. RESULTS: Most (78%) patients had a preserved LVEF of ≥50%. Major procedural complications were similar in the older and younger groups (3.2% vs 4.7%; P = 0.670). The recurrence-free survival and mortality rates were comparable between the 2 groups during a median follow-up period of 21.5 (12.0-37.0) months. The HF hospitalization rate was higher in the older group (4.0 vs 1.5 per 100 patient-years; P = 0.008). In the older group, LVEF and B-type natriuretic peptide levels improved after ablation (from 57.4% to 60.0%, and 173 [113-292] to 87.8 [42-218] pg/mL). AF recurrence and HF hospitalization were closely linked, with most hospitalizations occurring after a year postablation. CONCLUSIONS: CBA for AF in older patients with HF is feasible and improves cardiac parameters; however, specific care is required owing to this population's unique characteristics.