Pulmonary vein isolation with the pentaspline pulsed-field ablation in elderly patients Is it effective and safe?

Background Previous studies using cryoablation or radiofrequency have shown lower efficacy of pulmonary vein isolation (PVI) in patients aged ≥75 years for the treatment of atrial fibrillation (AF). Purpose To evaluate the effectiveness and safety of PVI using pulsed-field ablation (PFA) in a cohort of patients aged ≥75 years compared with those <75 years. Methods Patients referred consecutively for PVI, both <75 and ≥75 years old, were included. PVI was performed using a pentaspline pulsed-field catheter with a single transseptal puncture. Heparinization was administered after the transseptal puncture. At least four applications in the basket configuration and four in the flower configuration were recommended for each vein. Patients underwent routine clinical follow-up during the first year. Baseline characteristics were compared, and survival analysis, comparative analysis of complications, and univariate and multivariate analyses for predictors of recurrence were performed. Results A total of 230 patients were included (51 aged ≥75 years). Elderly patients were more frequently female, more often hypertensive, had lower body weight, presented more persistent AF, and were more frequently in AF at the time of ablation (figure 1). In the survival analysis, 83% of patients <75 years and 78% of those ≥75 years were free from arrhythmia after one year of follow-up (log-rank 0.401). The complication profile was similar with no statistical differences (1 embolism in each group; 1 cardiac tamponade in <75 years vs. 2 in ≥75 years). Recurrences were in the form of AF in 91% of patients ≥75 years compared to 81% of those <75 years. In the univariate analysis, only prior heart disease was a statistically significant predictor, and it remained the strongest predictor in the multivariate model. Age or being > or ≤75 years was not a predictor of recurrence. Conclusions PVI using a pentaspline PFA catheter in elderly patients aged ≥75 years shows a rate of arrhythmic recurrence and a complication profile very similar to those observed in patients <75 years.Baseline characteristics.Primary endpoint.