Comparative Analysis of Pulsed-Field and Cryoballoon Ablation in Octogenarians with Atrial Fibrillation: a Multicenter Study

Abstract Background The prevalence of atrial fibrillation (AF) increases with advancing age, and AF contributes to higher rates of stroke, dementia, heart failure, and mortality. Catheter ablation is recognized as an effective treatment for AF; however, data regarding its efficacy in octogenarians are limited. Cryoballoon ablation (CBA) has been reported to be safe and effective in this age group. Recently, single-shot devices using pulsed-field energy have been developed, offering a tissue-specific effect. However, data on the safety and effectiveness of this novel pulsed-field ablation (PFA) in octogenarians are still insufficient. Purpose This study aims to evaluate the procedural outcomes and complications of PFA in octogenarians with AF, in comparison to CBA, from 3 high-volume European centers. Methods We retrospectively enrolled patients who underwent PFA via the FarapulseTM system from January 2022 to June 2023, and those who underwent second-generation CBA from January 2015 to June 2023. Results A total of 176 patients (PFA group: 63, CBA group: 113) were included. The PFA group had a higher proportion of patients with persistent AF (p=0.03) and undergoing a repeat procedure (p<0.01). (Table 1) Unlike CBA, PFA procedures involved additional extrapulmonary targets, such as posterior wall and mitral isthmus. Nonetheless, procedure time was similar between groups. There were no significant differences in complications but phrenic nerve palsy was not observed in the PFA group (Table 2). Conclusions PFA for octogenarians provides the possibility to target additional extrapulmonary sites with equivalent procedural times and safety compared to CBA, without the concern of phrenic nerve palsy.Table 1Table 2