Cryoballoon Ablation in Older Patients With Heart Failure: Insights From a Large-Scale Multicenter Clinical Study

TL;DR

Cryoballoon ablation is safe and effective for older patients with heart failure and atrial fibrillation, though they may need special care due to higher hospitalization risks.

Contribution

This study provides insights into the safety and outcomes of cryoballoon ablation in older patients with heart failure.

Findings

Cryoballoon ablation had similar procedural complication rates in older and younger patients with heart failure.

Older patients showed improved left ventricular ejection fraction and B-type natriuretic peptide levels after ablation.

Heart failure hospitalization rates were higher in older patients, mostly after one year postablation.

Abstract

Cryoballoon ablation (CBA) achieves satisfactory outcomes in patients with atrial fibrillation (AF). However, its feasibility in older patients with heart failure (HF) remains unclear.

This study examined the efficacy and prognosis of CBA in older patients with HF.

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.

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.

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.

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