P2839The golden age of ablation: results for atypical flutter ablation in the very elderly

Abstract Introduction Atypical flutter ablation (AFL) is a challenging procedure with limited long-term benefits and not exempt from significant risks. Purpose To compare the efficacy and safety of this procedure in a population of octogenarian patients over a population of younger patients. Methods From 2015 to 2018, all patients in which AFL ablation was attempted were included. Activation and voltage mapping were used to define AFL circuit. Radiofrequency lesions were performed to operator's discretion until AFL termination. Programmed atrial stimulation was repeated to test inducibility, and any sustained induced arrhythmia was ablated. Follow-up included visits with ECG and/or 24h Holter-ECG at 3 and 12 months. Results 107 patients (55 females) were included, 26 (24%) aged 80 or older (table). Successful ablation of the original circuit was achieved in 96% in both groups (acute success rate, p=0.973), with induction of other AFL circuits in 43% (46% octogenarians, 42% younger, p=0.708), successfully ablated in 88% in both groups (total success rate, p=0.952). No significant difference was detected in the rate of adverse events (8% in octogenarians versus 7% in younger, p=0.962), with a case of cardiac tamponade in the former, successfully resolved. After a mean follow-up of 11±12 months, 52 patients (49%) were free from recurrence, 13 (50%) in the octogenarian group and 39 (48%) in the younger, with an estimated median survival free from atrial arrhythmias of 26 months (95% CI: 4–48) in the octogenarian group and 18 months (95% CI: 5–32) in the younger group (p=0.716). After multivariate analysis, history of prior AF and indexed left atrial volume, but not age, predicted recurrence. Demographical and clinical variables All patients (n=107) Octogenarians (n=26) No octogenarians (n=81) p-value Age (years) 69±13 83±3 65±11 <0.0001* Cardiomyopathy (%) 54 (50%) 13 (26%) 41 (51%) 0.956 Left ventricular ejection fraction (%) 60±13 57±17 61±11 0.24 Indexed left atrial volume (ml/m2) 45±19 48±14 43±19 0.55 Prior AF history 49 (46%) 7 (27%) 42 (52%) 0.026* Prior ablation procedures 53 (50%) 8 (31%) 45 (56%) 0.028* Prior cardiac surgery 30 (28%) 2 (8%) 28 (35%) 0.008* Left AFL origin (%) 87 (81%) 24 (92%) 63 (78%) 0.098 *Statistically significant difference. Survival function Conclusion AFL ablation was as effective and safe in octogenarian as in younger ones, with a median survival time free from atrial arrhythmias of more than 2 years.