Recently, the electrophysiology team of the Department of Cardiology at the Shandong Provincial Hospital Affiliated to Shandong First Medical University (Shandong Provincial Hospital) successfully performed 3D radiofrequency ablation of atrial fibrillation guided by intracardiac echocardiography (ICE) for an 89-year-old patient with atrial fibrillation by the cooperation of medical workers at the intervention center.

　　The operation went smoothly and the patient recovered well. This patient have been the eldest one to receive radiofrequency ablation of atrial fibrillation in the hospital, which reflected the precision treatment level of radiofrequency technology in our hospital.

　　Mr. Ding is 89 years old who had suffered from atrial fibrillation for more than 10 years. He suffered from repeated symptoms such as palpitations, chest tightness, and shortness of breath. In recent years, he began to suffer from persistent atrial fibrillation. The effect of drug treatment was not obvious, which seriously affected the quality of life. The patient went to many hospitals for treatment, but he was thought too old to receive radiofrequency ablation. So he came to see Professor SONG Shangming for treatment at our hospital.

　　How to ensure the safety of the operation on such an elderly patient was the most important thing. Professor SONG Shangming led the electrophysiology team to hold many discussions on this issue. After analyzing the patient’s condition, everyone agreed that Mr. Ding was older, but his heart function was acceptable. He did not have other major diseases and the conservative treatment effect would not be satisfactory. After fully communicating with the patient and his family, Professor SONG Shangming decided to perform radiofrequency ablation of atrial fibrillation under the guidance of ICE.

　　The operation was used the classic 2C3L way. After zero rays penetrated the atrial septum under the guidance of ICE catheter, the 3D model of the left atrium was quickly and accurately established. The ablation of pulmonary vein antrum isolation + atria roof line, mitral valve isthmus line and tricuspid valve isthmus line were completed with high power. Atrial fibrillation was successfully terminated and the rhythm was converted to sinus rhythm. High power ablation greatly shortened the operative time, reduced the pain and improved the cooperation of patients during operation.

　　ICE significantly reduced the amount of X-ray exposure and avoided the use of contrast agents. During the operation, the pericardium was monitored in real time to make sure serious complications such as pericardial tamponade could be found at the earliest time possible, ensuring the safety and effectiveness of the operation to the greatest extent.

Preoperative electrocardiogram of atrial fibrillation

During ablation

Sinus rhythm restored after surgery

Ultrasound real-time monitoring

　　Atrial fibrillation is a geriatric disease. The incidence rate gradually increases with age. The incidence rate of people over 80 years old can reach 10%. Atrial fibrillation has become the most common cardiovascular disease in the elderly, which not only causes stroke because of thromboembolism but also seriously affects the quality of life of patients. Catheter ablation is currently the preferred method for treating atrial fibrillation and the effect is significantly better than drug therapy.

　　In the past, it was believed that with the growth of age, the atrial structure and electrophysiological characteristics of the elderly will naturally age, and the degree of fibrosis will gradually increase. In addition, the elderly often have multiple diseases such as hypertension, diabetes, and coronary heart disease, which significantly changes the atrial electroanatomical matrix and exacerbate atrial remodeling. These may affect the efficiency and safety of catheter ablation in treating atrial fibrillation. However, recent studies have shown that this is not the case.

　　The clinical trial, "safety and efficacy of catheter radiofrequency ablation in patients with atrial fibrillation over 80 years old" by LIU Shaowen's team in Shanghai, China, was published online in the journal PACE. The study found that pressure catheter ablation surgery on selected atrial fibrillation patients over 80 years old had good safety and efficiency. There are similar reports in foreign literature. It is believed that although the elderly are accompanied by more cardiovascular diseases, catheter ablation is still a safe and effective treatment for elderly patients with atrial fibrillation.

　　Professor SONG Shangming noted that the following points need to be done to ensure the perioperative safety in elderly patients.

　　1. Sufficient preoperative evaluation. For example, preoperative esophageal ultrasound examination is to confirm whether there is thrombosis in the atrium. Patient’s liver and kidney function status need to be checked to choose the appropriate anticoagulant drugs and manage well other concomitant diseases, etc.

　　2. ICE-guided ablation during operation. Compared with atrial fibrillation ablation under the traditional X-ray and 3D mapping system, ICE can provide a comprehensive and 3D view of the structure of heart cavity, and locate the ablation catheter more accurately. The real-time display of catheter attachment significantly improve the success rate of surgery. Changes in the cavity during the operation can be monitored in real time, and complications such as pericardial effusion can be found at the earliest time possible, which improves the safety of surgery. ICE can effectively reduce the amount of X-rays and reduces the radiation injury to surgeons and patients. The ICE-guided atrial septum puncture can intuitively indicate the optimal puncture position to perform safe and effective puncture. It can accurately locate the pulmonary vein opening and provide a reliable and effective plan for precise ablation. This technique can greatly improve the efficacy and safety of ablation in elderly patients with atrial fibrillation.

　　3. Take medicine according to the doctor's advice after surgery. Most patients need to take anticoagulants and antiarrhythmic drugs for 2 to 3 months after catheter ablation of atrial fibrillation. The elderly have many diseases and concurrent medications whose liver and kidney function have varying degrees of decline. Therefore, the patients may need personalized programs for anticoagulants and antiarrhythmic drugs. Taking medicine according to the doctor's advice and regular check-ups can reduce adverse reactions and improve the safety of taking medicine.

　　Although the elderly have more cardiovascular diseases, catheter ablation therapy can still achieve a good effect of restoring sinus rhythm without complications. Catheter ablation therapy is safe and feasible for elderly patients with atrial fibrillation.