Pulsed field ablation for atrial fibrillation in patients aged ≥75 years resulted in similar freedom from arrhythmia recurrence compared to younger patients (69.8% vs. 73.2%; p=0.66).
Observational (n=564)
No
Does pulsed field ablation for atrial fibrillation have similar safety and efficacy in older patients (≥ 75 years) compared to younger patients (< 75 years)?
Pulsed field ablation for atrial fibrillation in patients aged ≥ 75 years demonstrates similar overall safety and arrhythmia-free survival compared to younger patients, despite a higher risk of specific complications like vascular issues and pulmonary edema.
Absolute Event Rate: 69.8% vs 73.2%
p-value: p=0.66
ABSTRACT Background Older patients have been under‐represented in clinical trials of atrial fibrillation (AF) ablation. The safety of pulsed field ablation (PFA) in this cohort is not known. Methods We conducted an observational study of consecutive patients undergoing PFA with a pentaspline catheter (Farapulse, Boston Scientific) for AF at a tertiary centre comparing procedural and clinical outcomes in patients aged ≥ 75 years (older cohort) versus 30 s at any follow‐up. Results 564 consecutive patients underwent de novo PFA for AF between 2022 and 2025; 65 patients were aged ≥ 75 years (11.5%) (median age 77 years; younger cohort median age 62 years). The older cohort had a higher incidence of hypertension, vascular disease, lower eGFR, and lower body mass index ( p < 0.01 for all). There was no difference in lesion set or procedural time. There was no difference in overall major procedural complications (1.5%–1.6%; p = 0.97); however, older patients had more major vascular complications (3.1% vs. 0.2%; p = 0.003), pulmonary oedema (3.1% vs. 0.4%; p = 0.02), and transient renal impairment when assessed ( p = 0.007). At median follow‐up 6.3–7.0 months, there was no difference in freedom from arrhythmia recurrence between the older and younger cohorts (69.8% and 73.2%; p = 0.66). Conclusion Pulsed field ablation for AF can be performed in older patients with acceptable procedural safety and clinical outcomes. Clinical trials are needed to further determine the safety and efficacy of PFA in older patients.
Ha et al. (2026) conducted an observational in Atrial fibrillation (n=564). Pulsed field ablation vs. Younger patients (< 75 years) was evaluated on Freedom from arrhythmia recurrence (p=0.66). Pulsed field ablation for atrial fibrillation in patients aged ≥75 years resulted in similar freedom from arrhythmia recurrence compared to younger patients (69.8% vs. 73.2%; p=0.66).