Safety and acute efficacy of atrial fibrillation ablation using a pentaspline pulsed field ablation catheter in elderly patients over 80 years old: results from the FRANCE-PFA registry
C Chaumont, M Laredo, O Thomas, P Maury, G Massoullie, P Defaye, S Boveda, E Marijon, F Sacher, C De Chillou, F AnselmeAbstract
Introduction
There is limited evidence regarding the safety and efficacy of atrial fibrillation (AF) ablation using the first available pentaspline pulsed field ablation (PFA) catheter in elderly patients aged over 80 years.
Purpose
To describe procedural characteristics, acute efficacy, and safety outcomes of PFA in patients aged >80 years undergoing first-time AF ablation.
Methods
This was a subanalysis of the FRANCE-PFA prospective nationwide registry, which included all patients undergoing a first AF ablation using the pentaspline PFA catheter between March 2021 and February 2024 across 33 French centers. Procedural data were prospectively collected at a patient level. All patients aged >80 years were included in the present subanalysis.
Results
A total of 246 patients aged 82.4 ± 2.3 years were included (44.5% women; mean BMI 26.0 ± 4.0 kg/m²; CHA2DS2-VA score 3 ± 1). AF type was paroxysmal in 109 patients (44.3%), persistent in 114 (46.3%), and long-standing persistent in 23 (9.3%). Severe left atrial dilation was present in 19.5% of patients, moderate dilation in 53.7%, and no dilation in 26.8%. A reduced LVEF (<40%) was observed in 10.6% of patients. Mean procedure duration was 56.6 ± 25.2 minutes, and fluoroscopy time was 15.4 ± 8.9 minutes. Acute pulmonary vein isolation (PVI) was achieved in all patients. PVI only was performed in 108 patients (43.9%). Additional PFA lesion sets included the LA posterior wall in 110 (44.7%), the LA roof in 71 (28.9%), the mitral isthmus in 48 (19.5%), and the cavotricuspid isthmus in 19 (7.7%). Three major complications occurred (1.2%): one transient coronary spasm occurring after PFA was applied along the mitral isthmus, one hemoptysis during a procedure involving a straight guidewire, and one cardiac tamponade. No esophageal injury or symptomatic phrenic nerve palsy was observed at discharge. Sixty-eight patients (27.6%) were discharged on amiodarone, 13 (5.3%) on flecainide, and 5 (2%) on sotalol.
Conclusions
In this prospective nationwide registry, PFA in patients over 80 years of age appeared safe and acutely effective, with a low complication rate. These results support the use of AF ablation using PFA as a suitable ablation strategy in elderly patients.