Author + information
- Received August 30, 1993
- Revision received November 22, 1993
- Accepted December 9, 1993
- Published online May 1, 1994.
- Laurence M. Epstein, MD∗,1,
- Nancy Chiesa, RN,
- Marilynn Namekawa Wong, RN,
- Randall J. Lee, MD,
- Jerry C. Griffin, MD, FACC,
- Melvin M. Scheinman, MD, FACC and
- Michael D. Lesh, MD, FACC
- ↵∗Address for correspondence: Dr. Laurence M. Epstein, Room MU 433, Box 1354, 500 Parnassus Avenue, San Francisco, California 94143-1354.
Objectives. The purpose of this study was to evaluate the efficacy and safety of radiofrequency catheter ablation for the treatment of supraventricular tachycardias in an elderly (≥70 years of age) group of patients.
Background. Supraventricular tachycardias are the most common form of cardiac arrhythmia and affect all age groups. Although usually well tolerated in youth, supraventricular tachycardias may be associated with disabling symptoms and have lifethreatening potential 10 the elderly. In addition, antiarrhythmic agents are less well tolerated and may be associated with a higher incidence of toxicity in the elderly.
Methods. From May 1989 to March 1993, 454 patients underwent a radiofrequency catheter ablation procedure at the University of California, San Francisco, for the treatment of symptomatic supraventricular tachycardia. Sixty-seven of these patients were ≥70 years of age and constituted the study group. Patients underwent one of the following catheter ablation procedures: complete atrioventricular (AV) junctional ablation for ventricular rate control in patients with atrial fibrillation (37 patients), AV node modification for the treatment of AV node reentrant tachycardia (17 patients), accessory pathway ablation (9 patients), ablation of the “slow zone” to cure atrial flutter (4 patients) and atrial tachycardia ablation (1 patient). One patient underwent ablation for both AV node reentrant tachycardia and atrial flutter.
Results. Success was achieved in 67 (98.5%) of 68 ablation procedures. There were no procedural or early deaths. The overall complication rate was 7.4%, and only one patient (1.5%) had long-term sequelze (permanent cardiac pacing for complete heart block). At a mean (±SD) follow-np of 22.1 ± 12.9 months, 63 (94%) of 67 patients were alive, with no antiarrhythmic agents for the treatment of their presenting arrhythmia.
Conclusions. In this series radiofreqnency catheter ablation appears to be an effective and safe treatment option for elderly patients (≥70 yean of age) with a variety of symptomatic, drug-resistant supraventricular tachycardias. Because of the high incidence of severe symptoms associated with tachycardic episodes, the expense and the possible severe proarrhythmic problems associated with antiarrhythmic medications in this age group, catheter ablation may be considered an early rather than a “last resort” treatment option.
↵1 Drs. Epstein and Lesh serve on the scientific advisory board of EP Technologies, Sunnyvale, California and receive honoraria for their participation.
☆ All editorial decisions for this article, including selection of referees, were made by a Guest Editor. This policy applies to all articles with authors from the University of California, San Francisco.
- Received August 30, 1993.
- Revision received November 22, 1993.
- Accepted December 9, 1993.