Safety and efficacy of pulsed-field ablation for atrial fibrillation in the elderly: A EU-PORIA sub-analysis
- PMID: 39245073
- DOI: 10.1016/j.ijcard.2024.132522
Safety and efficacy of pulsed-field ablation for atrial fibrillation in the elderly: A EU-PORIA sub-analysis
Abstract
Background: The role of catheter ablation in elderly patients with atrial fibrillation (AF) is unclear. Pulsed field ablation (PFA) demonstrates a favorable clinical profile, however, data on elderly patients are lacking.
Aims: We aimed to assess the safety and efficacy of PFA in the elderly, using data from the EU-PORIA registry.
Methods: Periprocedural complications and long-term safety and efficacy outcomes of AF ablation using the pentaspline PFA catheter (Farapulse™) were compared between patients older than 80 years old and their younger counterparts, across seven European centers.
Results: Among the 1233 patients in the registry, 88 (7.1 %) were older than 80 years. Elderly patients were more often females (51.1 % vs 37.8 %, p = 0.01) with a lower median BMI (26.0, IQR:23.5-29.2 vs 26.9, IQR:24.4-30.4 kg/m2, p = 0.02), a higher median CHA2DS2-VASc score (4, IQR:3-5 vs 2, IQR:1-3, p < 0.001) and a higher incidence of hypertension (73.9 % vs 52.7 %, p < 0.001). In both groups, most patients had paroxysmal AF (58.0 % vs 60.3 %, p = 0.65). Ablation in the elderly was more frequently performed with minimally interrupted anticoagulation (87.5 % vs 59.7 %, p < 0.001). Despite comparable rates of overall complications (5.7 % vs 3.5 %, p = 0.29), elderly patients had a higher incidence of stroke (2.3 % vs 0.3 %, p = 0.04). At 12 months, major adverse clinical events (4.5 % vs. 2.1 %, p = 0.12) and arrhythmia-free survival (70 % vs 74 %, p = 0.69) were comparable in both groups. None of the recurrence-free elderly patients were on antiarrhythmic drugs at the end of follow-up.
Conclusion: In this real-world cohort, the efficacy of PFA for AF was similar in elderly and younger patients. Despite comparable complication rates, a higher incidence of stroke was observed in the elderly.
Keywords: Atrial fibrillation; Catheter ablation; Elderly; Octogenarians; Pulsed field ablation.
Copyright © 2024 Elsevier B.V. All rights reserved.
Conflict of interest statement
Declaration of competing interest R.M.: none. V.S.: none. B.S. is a consultant for and has received honoraria as well as research funding from Abbott, Medtronic, Boston Scientific, and Biosense Webster. S.B. has received honoraria from Medtronic and Biosense Webster. K.R.J.C. is a consultant for and has received honoraria as well as research funding from Abbott, Medtronic, Boston Scientific, and Biosense Webster. T.R. has received research grants from the Goldschmidt-Jacobson Foundation, the Swiss National Science Foundation, the Swiss Heart Foundation, and the sitem insel support fund, all for work outside the submitted study. He has received speaker/consulting honoraria or travel support from Abbott/SJM, Bayer, Biosense-Webster, Biotronik, Boston-Scientific, Daiichi Sankyo, Farapulse, Medtronic, and Pfizer-BMS, all for work outside the submitted study. He has received support for his institution's fellowship program from Abbott/SJM, Biosense-Webster, Biotronik, Boston-Scientific, and Medtronic for work outside the submitted study. T.K.: none. K.N. is a consultant for Biosense Webster, Boston Scientific, Field Medical, and LifeTech Scientific. N.R.: consultant for Boston Scientific. J.H.: speakers fees from Boston Scientific and Biosense Webster. M.H.R.: none. P.v.d.V.: none. Y.B. has received research grants from Medtronic and Atricure. He has received speaker/consulting honoraria from Abbott/SJM and Boston-Scientific, all for work outside the submitted study. S.J.: none. B.A.M.: none. S.B. is consultant for Medtronic, Boston Scientific, Microport, and Zoll.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical
