title: Risk and outcome after ablation of isthmus-dependent atrial flutter in elderly patients.
abstract: OBJECTIVE
  To study the influence of age on the clinical presentation and long-term outcome of patients referred for atrial flutter (AFL) ablation. Age-related differences have been reported regarding the prognosis of arrhythmias.
  
  
  METHODS
  A total of 1187 patients with a mean age 65±12 years consecutively referred for AFL ablation were retrospectively analyzed in the study.
  
  
  RESULTS
  445 (37.5%) patients were aged ≥70 (range 70 to 93) among which 345 were aged 70 to 79 years (29.1%) and 100 were aged ≥80 (8.4%). In multivariable analysis, AFL-related rhythmic cardiomyopathy and presentation with 1/1 AFL were less frequent (respectively adjusted OR = 0.44, 0.27-0.74, p = 0.002 and adjusted OR = 0.29, 0.16-0.52, p<0.0001). AFL ablation-related major complications were more frequent in patients ≥70 although remained lower than 10% (7.4% in ≥70 vs. 4.2% in <70, adjusted OR = 1.74, 1.04-2.89, p = 0.03). After 2.1±2.7 years, AFL recurrence was less frequent in patients ≥70 (adjusted OR = 0.54, 0.37-0.80, p = 0.002) whereas atrial fibrillation (AF) occurrence was as frequent in the 70-79 and ≥80 age subsets. As expected, cardiac mortality was higher in older patients. Patients aged ≥80 also had a low probability of AFL recurrence (5.0%) and AF onset (19.0%).
  
  
  CONCLUSIONS
  Older patients represent 37.5% of patients referred for AFL ablation and displayed a <10% risk of ablation-related complications. Importantly, AFL recurrences were less frequent in patients ≥70 while AF occurrence was as frequent as in patients <70. Similar observations were made in patients ≥80 years. AFL ablation appears to be safe and efficient and should not be ruled out in elderly patients.
authors.affiliation: Department of Cardiology, Nancy University Hospital, Vandoeuvre-les-Nancy, France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Brembilla-Perrot
authors.affiliation: Department of Cardiology, Nancy University Hospital, Vandoeuvre-les-Nancy, France.
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Sellal
authors.affiliation: Department of Cardiology, Nancy University Hospital, Vandoeuvre-les-Nancy, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Olivier
authors.affiliation: Department of Cardiology, Nancy University Hospital, Vandoeuvre-les-Nancy, France.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Manenti
authors.affiliation: Department of Cardiology, Nancy University Hospital, Vandoeuvre-les-Nancy, France.
authors.forename: Thibault
authors.initials: T
authors.lastname: Villemin
authors.affiliation: Department of Cardiology, Nancy University Hospital, Vandoeuvre-les-Nancy, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Beurrier
authors.affiliation: Department of Cardiology, Nancy University Hospital, Vandoeuvre-les-Nancy, France.
authors.forename: Christian
authors.initials: C
authors.lastname: De Chillou
authors.affiliation: INSERM, Centre d'Investigations Cliniques 1433, Université de Lorraine, Institut Lorrain du cœur et des vaisseaux, CHU de Nancy, Nancy, France.
authors.forename: Zohra
authors.initials: Z
authors.lastname: Lamiral
authors.affiliation: INSERM, Centre d'Investigations Cliniques 1433, Université de Lorraine, Institut Lorrain du cœur et des vaisseaux, CHU de Nancy, Nancy, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Girerd
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001282:Atrial Flutter / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome