-Original-

Urgent Catheter Ablation in Octogenarians with Serious Tachyarrhythmias

Kenta Takahashi, Meiso Hayashi, Yu-ki Iwasaki, Yasushi Miyauchi, Kenji Yodogawa, Ippei Tsuboi, Hiroshi Hayashi, Eiichiro Oka, Kanako Hagiwara, Yu-hi Fujimoto and Wataru Shimizu

Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan

Background: Urgent catheter ablation is often required for various tachyarrhythmias; however, its efficacy and safety in elderly patients have not been fully elucidated.
Methods: This study included consecutive octogenarians who underwent urgent radiofrequency catheter ablation (RFCA) for various serious tachyarrhythmias (urgent group, n=28) that were life-threatening, hemodynamically deleterious, or provoking ischemia, and consecutive octogenarians who underwent elective RFCA (control group, n=36). The rate of a successful RFCA, complications, later arrhythmia recurrences, and mortality were compared between the groups.
Results: There was no significant difference in the breakdown of the targeted arrhythmias between the groups, and common-type atrial flutter was most often targeted in both the urgent group (57%) and the elective group (56%). Compared with the control group patients, the patients of the urgent group were older (84±3 vs. 82±2 years P=0.001), with a higher frequency of baseline heart disease (68% vs. 17%, P<0.001) and lower left ventricular ejection fraction (45%±15% vs. 68%±10%, P<0.001). The rates of acute success (100% vs. 100%, P=1.00) and later arrhythmia recurrences (4% vs. 14%, P=0.22) were comparable between the groups. Two patients in the urgent group and 2 in the elective group had procedure-related nonlethal complications (7% vs. 6%, P=1.00): groin hematoma in 2, pressure ulcer in 1, and CO₂ narcosis in 1. There were no in-hospital deaths, and mortality during follow-up did not differ between the urgent and elective groups (6.0% vs. 3.9% per year, log-rank P=0.38).
Conclusion: Even in octogenarian patients, urgent catheter ablation for serious tachyarrhythmias can be safely performed with a high success rate and acceptable prognosis.

J Nippon Med Sch 2016; 83: 62-70

Keywords
octogenarian, arrhythmias, catheter ablation, heart failure, complication

Correspondence to
Meiso Hayashi, MD, FAHA, Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
m-h4510@nms.ac.jp

Received, October 28, 2015
Accepted, December 28, 2015