Periprocedural Safety of Interventional Electrophysiological Procedures in Octogenarians and Nonagenarians

Background: Catheter ablation is an established treatment for cardiac arrhythmia. There is a lack of data on invasive electrophysiological (EP) procedures in aged patients. Methods: Consecutive patients >= 80 years who underwent catheter ablation or left atrial appendage closure procedures between January 2005 and December 2017 in a high-volume center were retrospectively studied and compared to a matched control group of individuals < 80 years of age. Results: The aged group consisted of 486 patients who underwent 566 procedures at a mean age of 82.7 +/- 2.5 years (range 80-95 years). A cohort of 480 patients aged < 80 years (mean age 64.1 +/- 13.3 years) with 566 procedures served as a control group. Performed procedures were atrial arrhythmia ablation including atrial fibrillation treatment (n = 366, 64.7%), cavotricuspid isthmus ablation (n = 139, 24.6%), ablation of ventricular arrhythmias (n = 57, 10.1%), and left atrial appendage closure (n = 12, 2.1%). There were numerically more procedures with major complications after treatment of elderly patients (32 [5.7%] vs. 21 [3.5%] procedures, p = 0.12), as well as numerically more procedures accompanied by intrahospital deaths (6 [1.1%] vs. 1 [0.2%] procedure, p = 0.12). The rate of minor complications was significantly higher in aged patients as compared to younger controls (31 [5.1%] vs. 17 [20%] procedures, p = 0.039). Conclusion: Invasive EP procedures in octogenarians and nonagenarians are feasible, however a significantly higher incidence of minor periprocedural complications and a trend toward more severe complications and intrahospital fatalities were observed compared to younger patients. These findings support an individual risk-benefit assessment for elderly individuals before invasive EP treatments are conducted.