Mortality and safety of catheter ablation for antiarrhythmic drug-refractory ventricular tachycardia in elderly patients with coronary artery disease.
BACKGROUND
As the population ages, recurrent ventricular tachycardia (VT) is increasingly encountered in elderly patients with ischemic heart disease. Radiofrequency catheter ablation is useful for reducing VT therapy in patients with an implantable defibrillator. The utility of radiofrequency catheter ablation in the elderly is not well defined.


OBJECTIVE
The purpose of this study was to evaluate the prognosis and safety of radiofrequency catheter ablation of postinfarct VT in elderly patients.


METHODS
Radiofrequency catheter ablation was performed in 285 consecutive patients with recurrent postinfarct VT refractory to antiarrhythmic drugs. Mortality and outcomes were compared for an elderly group (age >or=75 years, n = 72) and a younger group (age <75 years, n = 213).


RESULTS
The groups were similar with regard to baseline characteristics, except for a greater number of females in the elderly group (20.8% vs 10.8%, P = .03). Inducible VTs were abolished or modified in 79.2% of the elderly group and 87.8% of the younger group (P = .12). Major complications occurred in 5.6% of elderly patients and 2.3% of younger patients (P = .48). Periprocedural mortality was similar between both groups (2/72 in elderly and 9/213 in younger group, P = .74). During mean follow-up of 42 +/- 33 months, 50.0% of the elderly group and 35.2% of the younger group died (P = .08). No VT was observed in 63.9% of the elderly patients and 60.1% of the younger patients, respectively (mean follow-up 18 +/- 24 months, P = .80).


CONCLUSIONS
Outcomes of catheter ablation are similar for selected elderly and younger patients. Advanced age should not preclude ablation when recurrent VT is adversely affecting quality of life in elderly patients who otherwise have a reasonable expectation for survival.
Inada
Keiichi
K
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. kinada@partners.org
Roberts-Thomson
Kurt C
KC
Seiler
Jens
J
Steven
Daniel
D
Tedrow
Usha B
UB
Koplan
Bruce A
BA
Stevenson
William G
WG
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation / Q000009:adverse effects* / Q000401:mortality / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000473:pathology*; D017147:Defibrillators, Implantable; D005260:Female; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D012737:Sex Factors; D013015:Sotalol / Q000627:therapeutic use; D017180:Tachycardia, Ventricular / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D017211:Treatment Failure
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D013015:Sotalol; D000638:Amiodarone