Safety and Efficacy of Pulsed Field Ablation for Atrial Fibrillation in Elderly Patients

ABSTRACT Background Pulsed‐field ablation (PFA) is increasingly used for catheter ablation of atrial fibrillation (AF), but older patients remain underrepresented in clinical trials. This study aimed to compare procedural outcomes and mid‐term effectiveness of PFA in patients aged ≤ 75 and > 75 years. Methods In this retrospective single‐center cohort, 479 consecutive patients underwent PFA for AF between January 2022 and April 2024. Patients were grouped by age (≤ 75 vs. > 75 years at ablation). Procedural parameters and acute complications were compared. Arrhythmia‐free survival was assessed with Kaplan–Meier analysis after an 8‐weeks blanking period, and predictors of recurrence were evaluated using Cox regressions. Results Of 479 patients (mean age 65.0 ± 12.1 years; 73.6% males), 104 (21.7%) were > 75 years at ablation. Patients > 75 years had more comorbidities, including hypertension and impaired renal function. Pulmonary vein isolation was achieved in 99.8% of cases. Acute complication rates were similar between groups (7.7% in > 75 vs. 8.5% in ≤ 75, p = 1.00), with low rates of tamponade (1.5%) and stroke (1.3%). Kaplan–Meier analysis showed no difference in arrhythmia‐free survival. At 6 months, freedom from atrial arrhythmia was 81.4% in the > 75 group and 83.8% in the ≤ 75 group ( p = 0.57); corresponding rates at 12 months were 60.1% and 68.6%. Age was not an independent predictor of recurrence. At last follow‐up, 75.7% of patients were off antiarrhythmic drugs. Conclusions PFA in patients > 75 years is associated with low complication rates and favorable rhythm outcomes, comparable to those in younger patients. These findings support the use of PFA in elderly patients with AF.