Key result
Age ≥80 predicts ~39% higher arrhythmia recurrence after PFA versus younger patients, despite similar safety.
Why the study?
Data on procedural safety and longer-term efficacy of pulsed field ablation for atrial fibrillation in very elderly patients remain limited.
Does pulsed field ablation for atrial fibrillation have comparable safety and efficacy in very elderly patients (≥80 years) versus younger patients?
Cohort (n=1,669)
No
Does pulsed field ablation for atrial fibrillation have comparable safety and efficacy in very elderly patients (≥80 years) versus younger patients?
Hazard Ratio: 1.39 (95% CI 1.03–1.88)
Absolute Event Rate: 48.7% vs 60.9%
p-value: p=0.03
Pulsed field ablation for atrial fibrillation in patients ≥80 years is safe with complication rates similar to younger patients, despite a higher recurrence rate at one year.
Supports PFA safety in patients ≥80 years; leaves open whether higher recurrence warrants age-specific strategies.
Background Pulsed field ablation (PFA) is increasingly being used for atrial fibrillation (AF) ablation because of its favorable safety profile. However, data on procedural safety and longer-term efficacy in very elderly patients remain limited. Objective To compare procedural safety and one-year efficacy of PFA in very elderly patients versus younger patients undergoing AF ablation. Methods Consecutive patients undergoing PFA for AF at a high-volume U.S. center were stratified by age ≥80 versus <80 years. Baseline characteristics, procedural outcomes, complications, and arrhythmia recurrence beyond a 90-day blanking period were compared. Kaplan-Meier analysis and multivariable Cox regression were used to evaluate recurrence. Results Among 1,669 patients, 130 were very elderly (median age 82 [81–84] years) and 1,539 were younger (69 [62–74] years). Very elderly patients had higher CHA 2 DS 2 -VASc scores and greater comorbidity burden, including more heart failure, valvular disease, peripheral arterial disease, and chronic lung disease. Procedure duration and fluoroscopy time were similar between groups. Major complications were rare and comparable between very elderly and younger patients (0.8% vs 0.4%; p=0.43), as were minor complications (1.5% vs 0.7%; p=0.27). At one year, freedom from arrhythmia recurrence was lower in very elderly patients (48.7% vs 60.9%; log-rank p=0.013). On multivariable analysis, age ≥80 years independently predicted recurrence (HR=1.39, 95%CI: 1.03-1.88; p=0.03), along with redo procedure and persistent AF. Conclusion In this large real-world cohort, PFA in very elderly patients was associated with very low complication rates comparable to younger patients, despite a substantially higher comorbidity burden; yet with higher recurrence rates.
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Watfa et al. (2026) conducted a cohort in Atrial Fibrillation (n=1,669). Age ≥80 years vs. Age <80 years was evaluated on freedom from arrhythmia recurrence (HR 1.39, 95% CI 1.03-1.88, p=0.03). Age ≥80 years predicted higher arrhythmia recurrence after pulsed field ablation vs younger patients (HR 1.39; 95% CI 1.03-1.88), though major complication rates were similarly low (0.8% vs 0.4%).
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