Ablation of AV Nodal Reentrant Tachycardia in Octogenarians: Safety and Efficacy in a Large Comprehensive Single‐Center Analysis

INTRODUCTION: Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common supraventricular tachycardia and is generally considered benign, with excellent outcomes following catheter ablation. However, data on procedural safety and efficacy in very elderly patients (≥ 80 years), who often present with multiple comorbidities and increased procedural risk, remain limited. This study aimed to evaluate acute efficacy and complication rates of slow pathway ablation or modulation (SPA/SPM) in octogenarians treated at a high-volume electrophysiology center. METHODS: We retrospectively analyzed all consecutive octogenarian patients undergoing first-time SPA/SPM for AVNRT between 2001 and 2024. The primary efficacy endpoint was non-inducibility of AVNRT at the end of the procedure. Safety endpoints included atrioventricular block (AVB), pericardial effusion, and vascular access complications. Clinical outcomes were compared with a large institutional cohort of 6,020 patients undergoing SPA/SPM across all age groups. RESULTS: A total of 106 octogenarian patients (mean age 83.6 years) were included. Acute procedural success was achieved in 104 patients (98.1%). Two procedures were terminated prematurely due to transient AV conduction disturbances. Post-procedural AVB occurred in two patients, requiring permanent pacemaker implantation in one case. Pericardial effusion requiring pericardiocentesis occurred in two patients. Four patients developed significant bleeding or vascular access complications, with one requiring surgical intervention. Mean hospital stay was 1.3 days. Compared with the overall cohort, complication rates were higher in octogenarians (AVB: 1.9% vs. 0.12%; pericardial effusion: 1.9% vs. 0.08%; bleeding: 3.8% vs. 0.37%), while procedural success remained similarly high. CONCLUSIONS: SPA/SPM for AVNRT in octogenarians is highly effective with excellent acute success rates comparable to younger populations. However, complication rates are increased compared with a large institutional cohort and previously reported data. These findings highlight the need for careful patient selection, thorough risk-benefit assessment, and tailored procedural strategies when considering catheter ablation in this growing and vulnerable patient population.