Pulsed Field Ablation for the Treatment of Octogenarians With Atrial Fibrillation

As patients with atrial fibrillation (AF) present with increasing age and comorbidities, the understanding of the safety and efficacy of catheter ablation in older patients is paramount. We sought to investigate outcomes of octogenarians undergoing catheter ablation of AF in the era of pulsed field ablation (PFA).

We retrospectively analyzed AF patients who underwent PFA with a pentaspline catheter. Patients were divided into two groups based on age: octogenarians (age ≥ 80 years) and younger group (age < 80 years). Baseline characteristics, procedural data, and recurrence of atrial arrhythmia during the follow-up course were compared between the groups.

Among 698 AF patients (69 ± 11 years old, 64% male), 124 (18%) were octogenarians and 574 (72%) were younger than 80 years. Octogenarians had a higher prevalence of comorbidities and underwent more extensive ablation, including the posterior wall and anterior wall. However, the procedure time, ablation catheter dwell time, and the fluoroscopy time did not differ between groups. There were zero complications in the octogenarian group and 9 in the younger group (p = 0.16). Early follow-up data showed comparable recurrence rate of atrial arrhythmias after an 8 week-blanking period (log-rank p = 0.80).

PFA was effective and demonstrated a highly safe profile for octogenarians despite higher baseline risks and more extensive ablation.