TY - JOUR
T1 - Safety and efficacy of pulsed-field ablation for atrial fibrillation in the elderly
T2 - A EU-PORIA sub-analysis
AU - Mené, Roberto
AU - Sousonis, Vasileios
AU - Schmidt, Boris
AU - Bordignon, Stefano
AU - Neven, Kars
AU - Reichlin, Tobias
AU - Blaauw, Yuri
AU - Hansen, Jim
AU - Ouss, Alexandre
AU - Reinsch, Nico
AU - Mulder, Bart A.
AU - Ruwald, Martin H.
AU - van der Voort, Pepijn
AU - Kueffer, Thomas
AU - Jacob, Sophie
AU - Chun, Kyoung Ryul Julian
AU - Boveda, Serge
N1 - Publisher Copyright:
© 2024 Elsevier B.V.
PY - 2024/12/15
Y1 - 2024/12/15
N2 - 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.
AB - 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.
KW - Atrial fibrillation
KW - Catheter ablation
KW - Elderly
KW - Octogenarians
KW - Pulsed field ablation
UR - https://www.scopus.com/pages/publications/85203441137
U2 - 10.1016/j.ijcard.2024.132522
DO - 10.1016/j.ijcard.2024.132522
M3 - Journal article
C2 - 39245073
AN - SCOPUS:85203441137
SN - 0167-5273
VL - 417
JO - International Journal of Cardiology
JF - International Journal of Cardiology
M1 - 132522
ER -