BACKGROUND: Catheter ablation is an effective treatment of atrial fibrillation. Pulsed field ablation (PFA) has emerged as a novel energy modality that relies on high-voltage electric fields to achieve cardiac tissue ablation. Data on its efficacy in the elderly are scarce. OBJECTIVE: This study aimed to evaluate the procedural details and clinical outcomes of PFA in patients >
75 years old. METHODS: Consecutive patients with atrial fibrillation >
75 years old undergoing PFA with the Farapulse system were enrolled at 6 high-volume centers. Procedural details and clinical outcomes were compared with those of patients undergoing second-generation cryoballoon ablation (CBA) and radiofrequency ablation (RFA). RESULTS: Of 983 patients, 221 underwent PFA, 216 CBA, and 546 RFA. Procedure times were shorter with PFA (72 ± 30 minutes) compared with CBA (77 ± 27 minutes) and RFA (99 ± 23 minutes
P <
.001). Extra-pulmonary vein ablation was performed in 74.2% PFA, 9.7% CBA, and 42.1% RFA (P <
.001). The major complication rate was 1.01% (n = 10) and was not significantly different between groups (1 PFA, 2 CBA, and 7 RFA
P = .578). Minor complications were observed in 1.4% PFA, 5.1% CBA, and 3.5% RFA (P = .093). The 1-year atrial tachyarrhythmia freedom in the propensity score-matched population was 77.2% with PFA, 80.8% with CBA, and 74.9% with RFA
P = .52). CONCLUSION: PFA is a safe and effective option for elderly patients, offering the advantage of enabling extra-pulmonary vein ablation without the concern of thermal injury risk.