title: Influence of advancing age on clinical presentation, treatment efficacy and safety, and long-term outcome of pre-excitation syndromes: a retrospective cohort study of 961 patients included over a 25-year period.
abstract: There are very little data on pre-excitation syndrome (PS) in the elderly. We investigated the influence of advancing age on clinical presentation, treatment and long-term outcome of PS.
  
  
  
  Single-centre retrospective study of patient files.
  
  
  
  In all, 961 patients (72 patients ≥60 years (mean 68.5±6), 889 patients <60 years (mean 30.5±14)) referred for overt pre-excitation and indication for electrophysiological study (EPS) were followed for 5.3±5 years. Usual care included 24 h Holter monitoring, echocardiography and EPS. Patients underwent accessory pathway (AP) ablation if necessary.
  
  
  
  Occurrence of atrial fibrillation (AF) or procedure-induced adverse event.
  
  
  
  Electrophysiological data and recourse to AP ablation (43% vs 48.5%, p=0.375) did not significantly differ between the groups. Older patients more often had symptomatic forms (81% vs 63%, p=0.003), history of spontaneous AF (8% vs 3%, p=0.01) or adverse presentation (poorly tolerated arrhythmias: 18% vs 7%, p=0.0009). In multivariable analysis, patients ≥60 years had a significantly higher risk of history of AF (OR=4.2, 2.1 to 8.3, p=0.001) and poorly tolerated arrhythmias (OR=3.8, 1.8 to 8.1, p=0.001). Age ≥60 years was associated with an increased major AP ablation complication risk (10% vs 1.9%, p=0.006). During follow-up, occurrence of AF (13.9% vs 3.6%, p<0.001) and incidence of poorly tolerated tachycardia (4.2% vs 0.6%, p=0.001) were more frequent in patients ≥60 years, although frequency of ablation failure or recurrence was similar (20% vs 15.5%, p=0.52). In multivariable analysis, patients ≥60 years had a significantly higher risk of AF (OR=2.9, 1.2 to 6.8, p≤0.01).
  
  
  
  In this retrospective monocentre study, patients ≥60 years referred for PS work up appeared at higher risk of AF and adverse presentation, both prior and after the work up. These results suggest that, in elderly patients, the decision for EPS and AP ablation should be discussed in light of their suspected higher risk of events and ablation complications. However, these findings should be further validated in future prospective multicentre studies.
authors.affiliation: Department of Cardiology, CHU de Nancy, Vandoeuvre-lès-Nancy, France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Brembilla-Perrot
authors.affiliation: Department of Cardiology, CHU de Nancy, Vandoeuvre-lès-Nancy, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Olivier
authors.affiliation: Department of Cardiology, CHU de Nancy, Vandoeuvre-lès-Nancy, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Sellal
authors.affiliation: Department of Cardiology, CHU de Nancy, Vandoeuvre-lès-Nancy, France.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Manenti
authors.affiliation: Department of Epidemiology, CHU of Besançon, Besançon, France.
authors.forename: Alice
authors.initials: A
authors.lastname: Brembilla
authors.affiliation: Department of Cardiology, CHU de Nancy, Vandoeuvre-lès-Nancy, France.
authors.forename: Thibaut
authors.initials: T
authors.lastname: Villemin
authors.affiliation: Department of Cardiology, CH of Epinal, Épinal, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Admant
authors.affiliation: Department of Cardiology, CHU de Nancy, Vandoeuvre-lès-Nancy, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Beurrier
authors.affiliation: INSERM, Centre d'Investigations Cliniques 1433, Université de Lorraine, CHU de Nancy, Institut Lorrain du cœur et des vaisseaux and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, Vandoeuvre-lès-Nancy, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Bozec
authors.affiliation: INSERM, Centre d'Investigations Cliniques 1433, Université de Lorraine, CHU de Nancy, Institut Lorrain du cœur et des vaisseaux and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, Vandoeuvre-lès-Nancy, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Girerd
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D017115:Catheter Ablation / Q000379:methods*; D004452:Echocardiography; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011226:Pre-Excitation Syndromes / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology
keywords: atrial fibrillation; elderly; electrophysiological study; pre-excitation