Background:
Pulmonary vein isolation (PVI) using a Cryo-Balloon has been established as a corner stone in the treatment of atrial fibrillation (AF). The impact of high age on the outcome has not been thoroughly investigated. 

Methods:
A total of 485 Patients ((264 men /221 women) age 25-89 years) underwent a first PVI for the treatment of drug refractory AF. The PVI was performed with the Cryo-Balloon (Arctic Front Advance™ and Arctic Front AdvancePro™). The patients were followed-up (Holter ECG and telephone calls) for at least one year. Success was defined as freedom of AF or atrial tachycardia (AT) after a follow-up period of 12 months after PVI.

The Patients were divided into two groups based on age (group I: < 75 years, mean 61 years, group II: ≥75 years, mean 78 years).

Results:
299 patients were included in group I (68% paroxysmal, 32% persistent AF) and 86 Patients in group II (56% paroxysmal, 44% persistent AF). The patients of group II showed a numerically higher prevalence of persistent AF but without statistical significance.

The recurrence rate of AF or AT was significantly higher in patients ≥ 75 yrs (45% recurrence after one year in group II vs. 27% in group I; p<0.01).

In contrast to group I, the recurrence rate in the older patient group was not influenced by the classification of AF. The recurrence rate in group II was 45% both for paroxysmal and persistent AF subgroups. However, younger patients presented with a recurrence rate of only 22% in paroxysmal, and of 35% in the persistent AF subgroup (p<0.01).

Conclusions: 
Performing PVI has been proven safe and feasible in all age groups. Arrhythmia recurrence in the elderly (≥75 years) occurs significantly more often than in younger patients. The well-known benefit of ablation at early stages with still paroxysmal AF seems not to apply to the elderly.