scholarly journals Efficacy and Safety of Ablation for Symptomatic Atrial Fibrillation in Elderly Patients: A Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Wei-Chieh Lee ◽  
Po-Jui Wu ◽  
Huang-Chung Chen ◽  
Hsiu-Yu Fang ◽  
Ping-Yen Liu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Elderly Patients ◽  
Meta Analysis ◽  
The Elderly ◽  
Cryoballoon Ablation ◽  
Efficacy And Safety ◽  
Af Ablation ◽  
Fluoroscopic Time ◽  
Procedural Time ◽  
Similar Incidence

Background: Age affects the efficacy of pharmacological treatment for atrial fibrillation (AF). Catheter ablation, including radiofrequency (RF) or cryoballoon ablation, is an effective strategy for symptomatic AF. This meta-analysis aimed to analyze the efficacy and safety of AF ablation in elderly patients with AF compared to non-elderly patients with AF.Methods: We searched several databases for articles published between January 1, 2008 and March 31, 2020. Eighteen observational studies with 21,039 patients were analyzed. Data including recurrence of AF or atrial tachyarrhythmia (ATA), complications, procedural time, and fluoroscopic time were compared between the elderly and non-elderly groups.Results: The elderly patients had significantly higher incidences of recurrent AF or ATA after AF ablation compared to the non-elderly patients (<60 years old) (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.11–1.33). The elderly patients had significantly higher incidences of complications of AF ablation compared to the non-elderly patients (OR, 1.37; 95% CI, 1.14–1.64). However, elderly AF patients with age ≥75 years old had similar incidence of recurrent AF or ATA and complication after AF ablation compared to non-elderly patients with AF.Conclusions: The elderly patients had significantly higher incidences of recurrent AF or ATA and complications after ablation for non-paroxysmal AF compared to non-elderly patients with AF (<60 years old), except in patients ≥75 years old.

Safety and efficacy of non-vitamin K antagonist oral anticoagulants in elderly patients with atrial fibrillation: systematic review and meta-analysis of 22 studies and 440 281 patients

2019 ◽  
Author(s):  
Angelo Silverio ◽  
Marco Di Maio ◽  
Costantina Prota ◽  
Elena De Angelis ◽  
Ilaria Radano ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Elderly Patients ◽  
Vitamin K ◽  
Meta Analysis ◽  
Vitamin K Antagonists ◽  
Indirect Comparison ◽  
Haemorrhagic Stroke ◽  
Intracranial Bleeding ◽  
Efficacy And Safety ◽  
Fatal Bleeding

Abstract Aims The aim of the present meta-analysis was to evaluate the efficacy and safety of non-vitamin K oral antagonists (NOACs) vs. vitamin K antagonists (VKAs) in elderly patients with atrial fibrillation (AF) and indirectly compare NOACs in this population. Methods and results MEDLINE, Cochrane, ISI Web of Sciences, and SCOPUS were searched for randomized or adjusted observational studies comparing NOACs vs. VKAs for stroke prevention in AF patients ≥75 years. The primary efficacy and safety outcomes of this meta-analysis were the composite of stroke and systemic embolism (SSE) and major bleedings, respectively. Other secondary outcomes were also analysed. The analysis included 22 studies enrolling 440 281 AF patients ≥ 75 years. The risk of SSE was significantly lower with NOACs vs. VKAs [hazard ratio (HR) 0.79; 95% confidence interval (CI) 0.70–0.89], whereas no differences were found for major bleedings (HR 0.94; 95% CI 0.85–1.05). NOACs reduced the risk of intracranial bleeding (HR 0.46; 95% CI 0.38–0.58), haemorrhagic stroke (HR 0.61; 95% CI 0.48–0.79) and fatal bleeding (HR 0.46; 95% CI 0.30–0.72) but increased gastrointestinal (GI) bleedings (HR 1.46; 95% CI 1.30–1.65), compared to VKAs. The adjusted indirect comparison showed no significant differences in term of SSE between NOAC agents. Conversely, the risk of major bleeding was higher for rivaroxaban vs. apixaban (HR 1.69; 95% CI 1.39–2.08) and edoxaban (HR 1.37; 95% CI 1.14–1.67), and for dabigatran vs. apixaban (HR 1.47; 95% CI 1.18–1.85). Conclusion In elderly patients with AF, NOACs are associated to a lower risk of SSE, intracranial bleeding, haemorrhagic stroke and fatal bleeding than VKAs, but increase GI bleedings. In this analysis, the safety profile of individual NOAC agents was significantly different.

P1908Left common pulmonary vein in atrial fibrillation ablation with cryoballoon. A meta-analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Gionti ◽  
M C Negro ◽  
M Longobardi ◽  
C Storti
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Outcome ◽  
Pulmonary Vein ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Cryoballoon Ablation ◽  
Inclusion Criteria ◽  
Af Ablation ◽  
The Impact ◽  
Common Pulmonary Vein

Abstract Background Conflicting results regarding the impact of left common pulmonary (LCPV) vein on clinical outcome of atrial fibrillation (AF) ablation with cryoballoon technology have been reported. In the present study, we sought to investigate the performance of the 28 mm cryoballoon advance (CB-A) on left common pulmonary vein (LCPV) in terms of post procedural outcome. Methods We systematically searched on PubMed and Cochrane library for the articles that compared the recurrence rate of AF after cryoballoon ablation between patients with four separate and distinct pulmonary vein ostia and with LCPV. Results A total of 5 studies with 1052 patients met our predefined inclusion criteria. Recurrence of AF after CB-A ablation was similar in both groups (Log OR 0.45; 95% CI: −0.03, 0.94; I=48%, p=0.08), Fig 1. Figure 1 Conclusion LCPV doesn't affect clinical outcome of AF ablation with cryoballoon technology.

scholarly journals Efficacy and safety of ablation index-guided catheter ablation for atrial fibrillation: an updated meta-analysis

EP Europace ◽  
2020 ◽  
Vol 22 (11) ◽  
pp. 1659-1671
Author(s):  
Adam Ioannou ◽  
Nikolaos Papageorgiou ◽  
Wei Yao Lim ◽  
Tanakal Wongwarawipat ◽  
Ross J Hunter ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
Ablation Index ◽  
Procedural Time ◽  
Force Time ◽  
European Society Of Cardiology ◽  
Procedural Outcomes

Abstract Aims  Despite recent advances in catheter ablation for atrial fibrillation (AF), pulmonary vein reconnection (PVR), and AF recurrence remain significantly high. Ablation index (AI) is a new method incorporating contact force, time, and power that should optimize procedural outcomes. We aimed to evaluate the efficacy and safety of AI-guided catheter ablation compared to a non-AI-guided approach. Methods and results  A systematic search was performed on MEDLINE (via PubMED), EMBASE, COCHRANE, and European Society of Cardiology (ESC) databases (from inception to 1 July 2019). We included only studies that compared AI-guided with non-AI-guided catheter ablation of AF. Eleven studies reporting on 2306 patients were identified. Median follow-up period was 12 months. Ablation index-guided ablation had a significant shorter procedural time (141.0 vs. 152.8 min, P = 0.01; I2 = 90%), ablation time (21.8 vs. 32.0 min, P < 0.00001; I2 = 0%), achieved first-pass isolation more frequently [odds ratio (OR) = 0.09, 95%CI 0.04–0.21; 93.4% vs. 62.9%, P < 0.001; I2 = 58%] and was less frequently associated with acute PVR (OR = 0.37, 95%CI 0.18–0.75; 18.0% vs 35.0%; P = 0.006; I2 = 0%). Importantly, atrial arrhythmia relapse post-blanking was significantly lower in AI compared to non-AI catheter ablation (OR = 0.41, 95%CI 0.25–0.66; 11.8% vs. 24.9%, P = 0.0003; I2 = 35%). Finally, there was no difference in complication rate between AI and non-AI ablation, with the number of cardiac tamponade events in the AI group less being numerically lower (OR = 0.69, 95%CI 0.30–1.60, 1.6% vs. 2.5%, P = 0.39; I2 = 0%). Conclusions  These data suggest that AI-guided catheter ablation is associated with increased efficacy of AF ablation, while preserving a comparable safety profile to non-AI catheter ablation.

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