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Comparative Study
. 2025 May 6;14(9):e037959.
doi: 10.1161/JAHA.124.037959. Epub 2025 Apr 23.

Does Age Impact Safety and Efficacy During Pulse-Field Ablation for Atrial Fibrillation?

Antonio Dello Russo  1   2 , Claudio Tondo  3 , Stefano Bianchi  4 , Vincenzo Schillaci  5 , Saverio Iacopino  6 , Michela Casella  2   7 , Antonio Rossillo  8 , Ruggero Maggio  9 , Sakis Themistoclakis  10 , Matteo Bertini  11 , Maurizio Russo  12 , Mario Volpicelli  13 , Graziana Viola  14 , Roberto Rordorf  15 , Marco Schiavone  3 , Yari Valeri  2 , Jacopo Colella  6 , Pietro Rossi  4 , Fabrizio Tundo  3 , Gianluca Zingarini  16 , Antonio De Simone  17 , Lorenzo Bianchini  3 , Alessandro Di Vilio  6 , Paolo Compagnucci  1   2 , Maurizio Malacrida  18 , Giulio Zucchelli  19 , Francesco Solimene  1   5
Affiliations
Comparative Study

Does Age Impact Safety and Efficacy During Pulse-Field Ablation for Atrial Fibrillation?

Antonio Dello Russo et al. J Am Heart Assoc. .

Abstract

Background: There is no evidence evaluating efficiency, effectiveness, and safety outcomes in older patients in the context of pulsed-field ablation technology for the ablation of atrial fibrillation. We aimed to compare safety, efficacy, and acute and long-term outcomes of pulsed-field ablation in older patients (≥75 years) with younger ones.

Methods: We enrolled consecutive patients who had undergone atrial fibrillation ablation with the pulsed-field ablation FARAPULSE system (Boston Scientific) at 15 centers. Patients were stratified by age (<65, 65-74, and ≥75 years) and efficacy and safety profiles of these groups were compared.

Results: A total of 1082 patients were included: 108 (10%) were ≥75 years old, 374 (34.6%) were 65-74 years old and 600 (55.4%) were <65 years old. Older patients displayed a more pronounced risk profile compared with their younger counterparts, characterized by a significant higher burden of comorbidities. No differences in terms of procedural metrics were found. Pulmonary vein isolation was achieved in all patients. An overall low rate of procedural-related complications was reported (3.0%) without difference between young and older patients (P=0.241). During a mean follow-up of 342±111 days, a primary efficacy end point occurred in 605 of 748 (80.9%) patients with available outcome information. The arrhythmia recurrence rate ranged from 14.4% in patients <65 years old to 26.9% of older patients (P=0.011).

Conclusions: Drawing from these findings, using the FARAPULSE system for atrial fibrillation ablation in older patients demonstrated swift, safe, and effective acute outcomes, mirroring a comparable pattern observed in younger patients and recurrence rates in line with the literature in older patients.

Registration: URL: clinicaltrials.gov; Unique Identifier: NCT05617456.

Keywords: age; atrial fibrillation; electroporation; older patients; pulsed‐field ablation.

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Conflict of interest statement

M. Malacrida is an employee of Boston Scientific. The remaining authors have no disclosures to report.

Figures

Figure 1
Figure 1. Percentage of patients, stratified by age, for catheter laboratory utilization and skin‐to‐skin time.
Percentage of patients for whom catheter laboratory utilization was ≤ 120 minutes or ≤ 90 minutes (A) and the percentage of patients for whom skin‐to‐skin time was ≤ 90 minutes or ≤ 60 minutes (B).
Figure 2
Figure 2. Survival curve from AF/AT recurrence during follow‐up after the 90‐day blanking period, according to young, young‐older, and older patients.
AF indicates atrial fibrillation; and AT, atrial tachycardia.
See this image and copyright information in PMC

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