Age not a factor in safety, effectiveness of pulse‐field ablation for AF

Pulsed-field ablation for atrial fibrillation (AF) appears to be equally safe and effective in older patients as it is in their younger counterparts, according to a study.

The study included 1,082 consecutive patients who had undergone AF ablation with a pulsed‐field ablation system across 15 centres in Italy. These patients were stratified by age (<65, 65–74, and ≥75 years), and efficacy and safety profiles of the ablation system were compared across these patient groups.

Of the patients, 108 (10 percent) were ≥75 years old, 374 (34.6 percent) were 65–74 years old, and 600 (55.4 percent) were <65 years old. Generally, older patients had a more pronounced risk profile, with a significantly higher burden of comorbidities, compared with their younger counterparts. Coronary artery disease, chronic kidney disease, chronic obstructive pulmonary disease, history of cancer, and hypertension were most prevalent among patients aged ≥75 years.

All patients achieved pulmonary vein isolation after the procedure. Overall, the rate of procedural‐related complications was low (3.0 percent), without difference between young and older patients (p=0.241).

Over a mean follow‐up of 342 days, the primary efficacy endpoint of arrhythmia recurrence occurred in 605 of 748 (80.9 percent) patients with available outcome information. The arrhythmia recurrence rate ranged from 14.4 percent among patients aged <65 years to 26.9 percent among older patients (p=0.011). The time to recurrence was longer for patients aged <65 years than for those aged 65–74 or ≥75 years (overall log‐rank p=0.0005).