Table 1.
Baseline characteristics and procedure-related indices of eligible studies.
|
First
Author |
Year | Study Design | Country | Sample Size | Elderly Age Cutoff (Years) | Gender (Female, %) | AF Type (PAF, %) | Hypertension (%) | DM (%) | |||||
| Elderly Group | Younger Group | Elderly Group | Younger Group | Elderly Group | Younger Group | Elderly Group | Younger Group | Elderly Group | Younger Group | |||||
| Natale [10] | 2021 | Observational single-center |
America | 221 | 352 | 75 | 100.0 | 100.0 | 10.9 | 14.8 | 69.7 $ | 53.4 | 10.9 | 14.8 |
| Vermeersch [6] | 2021 | Retrospective single-center | Belgium | 83 | 166 | 75 | 41.0 | 39.2 | 0 | 0 | 73.5 $ | 55.4 | 14.5 | 13.9 |
| Sciarra [11] | 2021 | Prospective multicenter | Italy | 726 | 1808 | 67 | 37.5 # | 23.4 | 73.6 | 75.5 | 62.8 $ | 41.3 | 7.2 & | 4.7 |
| Hartl [12] | 2021 | Observational single-center |
Germany | 299 | 487 | 70 | 44.5 # | 41.9 | 49.2 | 70.0 | 73.6 $ | 60.0 | NA | NA |
| Zhou [13] | 2020 | Observational single-center |
China | 89 | 244 | 80 | 55.1 | 59.4 | 64.0 | 62.7 | 75.3 | 64.8 | 36.0 & | 22.1 |
| Kanda [14] | 2019 | Retrospective single-center | Japan | 49 | 241 | 80 | 51.0 | 40 | 100.0 | 100.0 | 63.0 | 56.0 | 14.0 | 16.0 |
| Fink [15] | 2019 | Prospective multicenter |
Germany | 108 | 630 | 70 | 38.0 # | 27.6 | 55.6 | 63.0 | NA | NA | 9.3 | 6.3 |
| Zhang-1 [16] | 2019 | Retrospective single-center |
China | 127 | 550 | 75 | 55.1 # | 40.5 | 92.9 | 88.2 | 67.2 $ | 59.8 | 18.1 | 15.1 |
| Heeger [17] | 2019 | Prospective multicenter | Germany | 104 | 104 | 75 | 50.0 | 48.1 | 57.7 | 56.7 | 77.9 | 78.9 | 15.4 | 14.4 |
| Romero [18] | 2019 | Retrospective multicenter |
America | 3482 | 82,637 | 80 | 61.0 | 31.1 | NA | NA | 65.7 | 55.3 | 19.6 | 14.9 |
| Abdin [19] | 2019 | Retrospective single-center | Germany | 55 | 183 | 75 | 54.6 # | 34.5 | 31.0 | 40.5 | 85.4 $ | 69.3 | 20.0 & | 8.7 |
| Zhang-2 [20] | 2018 | Retrospective single-center | China | 308 | 360 | 60 | 41.5 # | 21.4 | 71.4 | 75.0 | 55.0 $ | 37.0 | 12.6 | 9.9 |
| Tscholl [21] | 2018 | Retrospective single-center | Germany | 40 | 40 | 75 | 50.0 | 35 | 45.0 | 47.5 | 80.0 | 60.0 | 10.0 | 12.5 |
| Moser [22] | 2017 | Retrospective multicenter | Germany | 227 | 4222 | 75 | 48.0 # | 31.1 | 59.9 | 63.3 | NA | NA | 8.8 | 7.6 |
| Abugattas [23] | 2017 | Retrospective single-center | Belgium | 53 | 106 | 75 | 54.7 | 41.5 | 100.0 | 100.0 | 79.2 $ | 41.3 | 11.3 | 8.7 |
| Kautzner [24] | 2017 | Retrospective single-center | Czech Republic | 394 | 2803 | 70 | 49.0 # | 29.4 | 66.5 | 68.2 | 79.2 $ | 56.7 | 15.7 & | 11.2 |
| Bunch-2 [25] | 2016 | Observational multicenter |
America | 46 | 877 | 80 | 58.7 # | 40.2 | 52.2 | 54.7 | 82.6 | 70.0 | 17.4 | 22.1 |
| Lioni [26] | 2014 | Retrospective single-center | Greece | 95 | 221 | 65 | 49.5 | 41.2 | 100.0 | 100.0 | 41.1 | 33.5 | 20.0 & | 6.8 |
| Santangeli [27] | 2012 | Retrospective single-center | America | 103 | 2651 | 80 | 41.0 # | 28.0 | 25.0 | 27.0 | 48.0 $ | 37.0 | 15.0 | 11.0 |
| Hao [28] | 2012 | Retrospective multicenter | America | 1325 | 4622 | 65 | 41.0 # | 23.0 | NA | NA | 68.0 | 57.0 | 21.0 | 16.0 |
| Bunch-1 [29] | 2010 | Retrospective single-center | America | 35 | 717 | 80 | 54.3 | 40.7 | 45.7 | 54.1 | 57.1 | 49.2 | 8.6 | 12.4 |
| Kusumoto [30] | 2009 | Retrospective single-center | America | 61 | 179 | 75 | 39.3 # | 24.1 | 34.0 | 70.9 | NA | NA | NA | NA |
| Bhargava [31] | 2004 | Retrospective single-center | America | 103 | 220 | 60 | 23.3 | 18.2 | 52.4 | 54.5 | 35.0 $ | 20.9 | NA | NA |
| Liu [32] | 2022 | Multicenter single-arm | China | 270 | - | 80 | 42.6 | - | 65.6 | - | 73.7 | - | 29.3 | - |
| Akhtar [33] | 2020 | Single-center single-arm | America | 15 | - | 80 | 40.0 | - | 87.0 | - | 80.0 | - | 20.0 | - |
| Metzner [34] | 2016 | Single-center single-arm | Germany | 94 | - | 75 | 41.5 | - | 58.5 | - | 88.3 | - | 4.3 | - |
| Corrado [35] | 2008 | Single-center single-arm | America | 174 | - | 75 | 36.8 | - | 55.0 | - | 56.0 | - | 13.0 | - |
|
First
Author |
LVEF | CHA2DS2-VASc Score | LAD (mm) | AF History Duration | AADs Usage (Elderly vs. Younger) | |||||||||
| Elderly Group | Younger Group | Elderly Group | Younger Group | Elderly Group | Younger Group | Elderly Group | Younger Group | |||||||
| Natale [10] | 58.2 ± 9.6 | 57.8 ± 9.4 | NA | NA | 42.6 ± 7.8 | 41.9 ± 7.6 | NA | NA | NA | |||||
| Vermeersch [6] | 53.2 ± 9.4 | 54.4 ± 9.0 | NA | NA | 45.8 ± 7.8 | 45.6 ± 7.0 | 45.7 ± 46.2 M | 52.4 ± 61.1 M | NA | |||||
| Sciarra [11] | 58.8 ± 7.2 | 59.3 ± 6.9 | 2.4 ± 0.7 | 1.1 ± 0.9 | 22.9 ± 6.2 cm2 * | 21.8 ± 6.0 cm2 | 62.0 ± 107.1 M ξ | 52.0 ± 105.8 M | Failed ≥2 AADs (higher) | |||||
| Hartl [12] | 56.2 ± 5.9 | 56.8 ± 6.5 | NA | NA | 46.1 ± 7.0 * | 43.5 ± 6.9 | NA | NA | The proportion of AADs at baseline (equal) | |||||
| Zhou [13] | 62.7 ± 5.4 | 63.1 ± 5.7 | 4.3 ± 1.3 | 3.3 ± 1.4 | 41.2 ± 4.8 | 41.5 ± 6.2 | 12.0 (2.5-36.0) M | 24.0 (5.0-48.0) M | NA | |||||
| Kanda [14] | NA | NA | 3.8 ± 0.9 | 2.2 ± 1.4 | 40.0 ± 6.0 | 38.0 ± 6.0 | NA | NA | The proportion of AADs at baseline: Class I (lower), other classes (equal) | |||||
| Fink [15] | NA | NA | NA | NA | NA | NA | NA | NA | NA | |||||
| Zhang-1 [16] | 58.7 ± 9.0 | 61.5 ± 6.5 | 4.8 ± 1.6 | 2.6 ± 1.7 | 41.0 ± 5.3 | 41.3 ± 5.6 | NA | NA | The proportion of AADs at baseline, Class I, I and III (equal) | |||||
| Heeger [17] | NA | NA | 3.8 ± 1.1 | 2.1 ± 1.3 | 44.5 ± 5.6 | 44.5 ± 5.6 | NA | NA | NA | |||||
| Romero [18] | NA | NA | NA | NA | 40.8 ± 5.5 | 40.8 ± 6.6 | 24.6 ± 34.1 M | 21.9 ± 34.6 M | NA | |||||
| Abdin [19] | 51.6 ± 8.3 | 52.5 ± 8.0 | 4.0 ± 1.3 | 2.0 ± 1.3 | 49.2 ± 5.8 | 38.6 ± 6.1 | NA | NA | NA | |||||
| Zhang-2 [20] | 66.3 ± 5.7 | 69.1 ± 8.9 | NA | NA | NA | NA | NA | NA | NA | |||||
| Tscholl [21] | 63.0 (60.0, 66.0) | 65.0 (60.0, 70.0) | 4.0 (4.0, 5.0) | 2.0 (1.0, 3.0) | NA | NA | NA | NA | NA | |||||
| Moser [22] | NA | NA | 3.7 ± 1.0 | 1.7 ± 1.2 | 41.4 ± 7.2 | 40.9 ± 6.6 | NA | NA | NA | |||||
| Abugattas [23] | 59.2 ± 5.2 | 59.9 ± 6.4 | 4.0 ± 1.3 | 1.3 ± 1.2 | 42.5 ± 5.4 | 42.3 ± 5.7 | NA | NA | NA | |||||
| Kautzner [24] | 55.8 ± 8.8 | 56.4 ± 7.6 | 3.1 ± 1.3 | 1.5 ± 1.2 | NA | NA | NA | NA | The proportion of AADs at baseline (equal) | |||||
| Bunch-2 [25] | 53.8 ± 13.3 | 52.5 ± 11.4 | NA | NA | 41.2 ± 4.8 | 41.5 ± 6.2 | 12.0 (2.5-36) M | 24.0 (5.0-48.0) M | NA | |||||
| Lioni [26] | 60.0 ± 3.8 | 61.1 ± 4.0 | NA | NA | 42.6 ± 4.5 * | 39.5 ± 4.3 | 5.9 ± 5.1 Y ξ | 4.7 ± 4.4 Y | The proportion of AADs after ablation, Class I and III (equal) | |||||
| Santangeli [27] | 55.0 ± 12.0 | 57.0 ± 9.0 | NA | NA | 46.0 ± 5.0 | 45.0 ± 8.0 | 52.0 (24.0-78.0) M | 58.0 (31.0-96.0) M | Failed AADs (equal) | |||||
| Hao [28] | NA | NA | NA | NA | 24.8 ± 9.1 cm2 | 28.7 ± 9.5 cm2 | NA | NA | NA | |||||
| Bunch-1 [29] | 52.7 ± 13.2 | 51.3 ± 13.1 | NA | NA | NA | NA | NA | NA | NA | |||||
| Kusumoto [30] | NA | NA | NA | NA | 42.6 ± 4.5 | 39.1 ± 4.3 | 5.9 ± 5.1 Y | 4.7 ± 4.4 Y | The proportion of AADs after ablation, Class I and III (equal) | |||||
| Bhargava [31] | 51.4 ± 9.8 | 53.4 ± 7.6 | NA | NA | 43.4 ± 6.5 | 43.3 ± 13.2 | 6.5 ± 3.7 Y | 6.0 ± 4.8 Y | Failed AADs (equal) | |||||
| Liu [32] | 63.7 ± 7.2 | - | 3.9 ± 1.2 | - | 39.9 ± 6.3 | - | 2.9 ± 5.2 Y | - | - | |||||
| Akhtar [33] | 63.7 ± 3.5 | - | 4.2 ± 1.7 | - | 45.0 ± 1.2 | - | 8.9 ± 8.2 Y | - | - | |||||
| Metzner [34] | NA | - | 4.0 ± 1.0 | - | 44.8 ± 6.2 | - | 75.0 M Median | - | - | |||||
| Corrado [35] | 53.0 ± 7.0 | - | NA | - | 46.0 ± 6.0 | - | 7.0 ± 4.0 Y | - | - | |||||
| First Author | Key Points of Ablation Procedure | Ablation Strategy | Ablation Energy | Follow-Up (Months) | ||||||||||
| Natale [10] | Isolation of pulmonary veins, posterior wall and superior vena cava was performed in all patients. Non-pulmonary vein triggers from other areas were ablated based on operator’s discretion | PVI-plus | RF | 48.0 | ||||||||||
| Vermeersch [6] | PVI only | PVI | Cryo | 24.0 (18.4-25.5) | ||||||||||
| Sciarra [11] | PVI only | PVI | Cryo | 12.0 | ||||||||||
| Hartl [12] | PVI with or without additional linear ablation based on decision | PVI-plus | Cryo | 36.0 | ||||||||||
| Zhou [13] | After PVI, additional linear ablation was performed when necessary | PVI-plus | RF | 24.4 ± 9.6 | ||||||||||
| Kanda [14] | PVI with or without additional linear ablation based on decision | PVI-plus | Cryo | 12.0 | ||||||||||
| Fink [15] | PVI first, and then additional ablation strategies including the creation of right atrial and left atrial linear lesions including block of the cavo-tricuspid isthmus, or ablation of complex fractionated atrial electrograms were at the discretion of the operator | PVI-plus | RF | 14.9 | ||||||||||
| Zhang-1 [16] | PVI only | PVI | Cryo | 12.0 | ||||||||||
| Heeger [17] | PVI only | PVI | Cryo | 36.0 | ||||||||||
| Romero [18] | NA | NA | NA | NA | ||||||||||
| Abdin [19] | PVI only | PVI | Cryo | 11.8 ± 5.4 | ||||||||||
| Zhang-2 [20] | PVI with linear ablation | PVI-plus | RF | 6.0 | ||||||||||
| Tscholl [21] | PVI only | PVI | Cryo | 12.0 (6.0, 18.0) | ||||||||||
| Moser [22] | PVI first, and then ablation of fragmented signals and/or lines in the left atrial (mitral isthmus line, roof line, anterior line) were performed in order to achieve termination to sinus rhythm | PVI-plus | RF | 15.3 | ||||||||||
| Abugattas [23] | PVI only | PVI | Cryo | 12.0 | ||||||||||
| Kautzner [24] | All patients underwent PVI first, and then additional left atrial linear lesions, coronary sinus ablation, or electrogram-guided ablations were performed empirically according to the clinical presentation and inducibility of the arrhythmia during the procedure | PVI-plus | RF | 18.0-21.0 | ||||||||||
| Bunch-2 [25] | All patients underwent PVI first, and then additional ablation beyond PVI was performed based upon individual operator choice | PVI-plus | RF | 60.0 | ||||||||||
| Lioni [26] | PVI only | PVI | RF | 34.0 ± 15.1 | ||||||||||
| Santangeli [27] | Isolation of all the pulmonary vein antra and the posterior wall contained between the pulmonary veins first; then the ablation catheter was positioned at right atrium-superior vena cava junction, where mapping and ablation was performed. | PVI-plus | RF | 18.0 ± 6.0 | ||||||||||
| Hao [28] | NA | NA | RF | 1.0 W | ||||||||||
| Bunch-1 [29] | PVI with or without additional linear ablation based on decision | PVI-plus | RF | 12.0 | ||||||||||
| Kusumoto [30] | PVI with linear ablations (not routinely performed) | PVI-plus | RF | 12.0 | ||||||||||
| Bhargava [31] | PVI only | PVI | RF | 14.7 ± 5.2 | ||||||||||
| Liu [32] | PVI with or without additional linear ablation based on decision | PVI-plus | RF | 12.0 | ||||||||||
| Akhtar [33] | PVI first, then additional cavo-tricuspid isthmus ablation based on the discretion of the operator | PVI-plus | Cryo | 12.0 | ||||||||||
| Metzner [34] | Circumferential PVI was performed in all patients, then ablation of complex fractionated atrial electrograms and/or linear lesions were performed based on decision | PVI-plus | RF | 37.0 ± 20.0 | ||||||||||
| Corrado [35] | PVI and superior vena isolation | PVI-plus | RF | 20.0 ± 14.0 | ||||||||||
AF: atrial fibrillation; PAF: paroxysmal atrial fibrillation; DM: diabetes mellitus; LVEF: left ventricular ejection fraction; LAD: left atrial diameter; AADs: antiarrhythmic drugs; PVI: pulmonary vein isolation; PVI-plus: PVI plus linear ablation and/or substrate ablation RF: radiofrequency; Cryo: cryoablation; NA: not available. Note: #, $, &, *, and ξ represent the significantly higher proportion (elderly group vs. younger group) in terms of gender, hypertension, DM, LAD, and AF history duration, respectively. In the LAD column, cm2 represents the unit of left atrial area; in the AF history duration column, M and Y represent months and years, respectively. In the Follow-up column, W represents week.