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

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.

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.

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.

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.