Safety and Efficacy of Pulsed Field Ablation for Atrial Fibrillation in Older Patients: An Observational Study at a Large Tertiary Centre in Australia.

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 < 75 years (younger cohort). Baseline demographics, procedural characteristics, complications, and clinical outcomes were collected. Arrhythmia recurrence was defined as AF, atrial flutter, or atrial tachycardia > 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.