Pulsed field ablation in the elderly via a pentaspline multielectrode catheter: safety, efficacy, and comparison with cryoballoon devices

Background Catheter ablation is an effective treatment for atrial fibrillation (AF). Pulsed field ablation (PFA) has emerged as a novel energy modality, which relies on high-voltage electric fields to achieve cardiac tissue ablation. Data on its efficacy in the elderly are scarce. Purpose To evaluate the procedural details and clinical outcomes of PFA in patients>75 years old. Methods Consecutive AF patients>75 years old undergoing PFA via the FarapulseTM system were enrolled at 4 European centers. Procedural details and clinical outcomes were compared with those of patients undergoing second-generation CBA. Results Overall, 419 patients (PFA group: 221, CBA group: 198) were included. The PFA group had a higher prevalence of persistent AF (p=0.005) (Table 1). Despite no significant differences in procedure time, PFA patients underwent additional extrapulmonary vein ablation, targeting the posterior wall (69.7%) and mitral isthmus (39.8%). There were no significant differences in major complication rates. The incidence of minor complications was significantly higher with CBA, as a result of a higher incidence of transient phrenic nerve injury in the CBA group (5.6% vs 0.0%; p<0.001). The 1-year AF/AT-recurrence-free rate was 77.9% for PFA and 80.3% with CBA in paroxysmal AF (p=0.96) and 81.3% with PFA and 74.3% with CBA in persistent AF (p=0.61) (Table 2). Conclusions PFA in the elderly provides the possibility to perform additional extrapulmonary vein ablation with equivalent procedural times and higher safety compared to CBA, without the concern of collateral thermal injury to adjacent tissues.