Objective:

To report the long-term follow-up of elderly patients with paroxysmal atrial fibrillation treated with stereotactic arrhythmia radioablation (STAR).

Approach:

• Patient Enrollment: Patients aged 70 years or older with symptomatic AF and ineffective or unusable antiarrhythmic therapy were enrolled.
• Treatment Methodology: STAR was performed with a total dose of 25 Gy delivered with high precision to the target and organs at risk.
• Follow-Up: Longitudinal follow-up was maintained through clinical evaluations, ECG, echocardiography, and Holter monitoring.

Key Findings:

• 18 out of 20 enrolled patients underwent STAR.
• 44% of patients developed mild pericardial effusion at 12-month follow-up, which resolved in most cases by long-term follow-up.
• Quality of life improved significantly from 48 ± 15 at enrollment to 75 ± 15 at 12 months (P < 0.001).
• All patients experienced at least one AF recurrence, but reported a reduction in symptomatic arrhythmic events and antiarrhythmic drug usage.

Interpretation:

The data demonstrate the feasibility of STAR in elderly patients with paroxysmal AF.

Limitations:

• The treatment remains experimental and requires more comprehensive safety data.
• Efficacy needs further evaluation in a comparative study versus catheter ablation.

Conclusion:

Further studies are necessary to establish the safety and efficacy of STAR in elderly patients with paroxysmal AF.