title: Ablation of atrioventricular nodal reentrant tachycardia in the elderly: results from the German Ablation Registry.
abstract: BACKGROUND
  Catheter ablation (CA) is considered the treatment of choice for patients with atrioventricular nodal reentrant tachycardia (AVNRT). However, there is a tendency to avoid CA in the elderly because of a presumed increased risk of periprocedural atrioventricular (AV) nodal block.
  
  
  OBJECTIVE
  The purpose of this prospective registry was to assess age-related differences in the efficacy and safety of CA within a large population with AVNRT.
  
  
  METHODS
  A total of 3,234 consecutive patients from 48 German trial centers who underwent CA of AVNRT between March 2007 and May 2010 were enrolled in this study. The cohort was divided into three age groups: <50 years (group 1, n = 1,268 [39.2%]; median age = 40 [30.0-45.0] years, 74.1% women), 50-75 years old (group 2, n = 1,707 [52.8%]; 63.0 [58.0-69.0] years, 63.0% women), and > 75 years old (group 3, n = 259 [8.0%]; 79.0 [77.0-82.0] years, 50.6% women).
  
  
  RESULTS
  CA was performed with radiofrequency current (RFC) in 97.7% and cryoablation technology in 2.3% of all cases. No differences were observed among the three groups with regard to primary CA success rate (98.7% vs. 98.8 % vs. 98.5%; P = .92) and overall procedure duration (75.0 minutes [50.0-105.0]; P = .93). Hemodynamically stable pericardial effusion occurred in five group 2 (0.3%) and two group 3 (0.8%) patients but in none of the group 1 (P <.05) patients. Complete AV block requiring permanent pacemaker implantation occurred in two patients in group 1 (0.2%) and six patients in group 2 (0.4%) but none in group 3 (P = 0.41). During a median follow-up period of 511.5 days (396.0-771.0), AVNRT recurrence occurred in 5.7% of all patients. Patients >75 years (group 3) had a significantly longer hospital stay (3.0 days [2.0-5.0]) compared with group 1 (2.0 days [1.0-2.0]) or group 2 (2.0 days [1.0-3.0]) patients (P <.0001).
  
  
  CONCLUSIONS
  CA of AVNRT is highly effective and safe and does not pose an increased risk for complete AV block in patients over 75 years of age, despite a higher prevalence of structural heart disease. Antiarrhythmic drug therapy is often ineffective in this age group; thus, CA for AVNRT should be considered the preferred treatment even in elderly patients.
authors.affiliation: University Heart Center, Department of Cardiology/Electrophysiology, Hamburg, Germany. b.hoffmann@uke.de
authors.forename: Boris A
authors.initials: BA
authors.lastname: Hoffmann
authors.forename: Johannes
authors.initials: J
authors.lastname: Brachmann
authors.forename: Dietrich
authors.initials: D
authors.lastname: Andresen
authors.forename: Lars
authors.initials: L
authors.lastname: Eckardt
authors.forename: Ellen
authors.initials: E
authors.lastname: Hoffmann
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.forename: Burghard
authors.initials: B
authors.lastname: Schumacher
authors.forename: Stefan G
authors.initials: SG
authors.lastname: Spitzer
authors.forename: Petra
authors.initials: P
authors.lastname: Schirdewahn
authors.forename: Jürgen
authors.initials: J
authors.lastname: Tebbenjohanns
authors.forename: Martin
authors.initials: M
authors.lastname: Horack
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.forename: Tushar V
authors.initials: TV
authors.lastname: Salukhe
authors.forename: Thomas
authors.initials: T
authors.lastname: Rostock
authors.forename: Stephan
authors.initials: S
authors.lastname: Willems
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000379:methods* / Q000706:statistics & numerical data; D003452:Cryosurgery / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome