Pulsed field ablation in the elderly by a pentaspline multielectrode catheter: Safety, efficacy, and comparison with cryoballoon and radiofrequency devices

IF 5.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Heart rhythm Pub Date : 2025-07-01 DOI:10.1016/j.hrthm.2025.01.025

Kazutaka Nakasone MD, PhD , Domenico G. Della Rocca MD, PhD , Michele Magnocavallo MD , Andres Betancur MD , Giampaolo Vetta MD , Luigi Pannone MD , Antonio Sorgente MD, PhD , Charles Audiat MD , Jesus Rodriguez MD , Ioannis Doundoulakis MD, PhD , Andrija Nekic MD , Vedran Velagić MD, PhD , Marco Polselli MD , Sanghamitra Mohanty MD , Lorenzo Marcon MD , Juan Sieira MD, PhD , Erwin Ströker MD, PhD , Gezim Bala MD, PhD , Stefano Bianchi MD, PhD , Alexandre Almorad MD , Gian-Battista Chierchia MD, PhD

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Abstract

Background

Catheter ablation is an effective treatment of atrial fibrillation. Pulsed field ablation (PFA) has emerged as a novel energy modality that relies on high-voltage electric fields to achieve cardiac tissue ablation. Data on its efficacy in the elderly are scarce.

Objective

This study aimed to evaluate the procedural details and clinical outcomes of PFA in patients >75 years old.

Methods

Consecutive patients with atrial fibrillation >75 years old undergoing PFA with the Farapulse system were enrolled at 6 high-volume centers. Procedural details and clinical outcomes were compared with those of patients undergoing second-generation cryoballoon ablation (CBA) and radiofrequency ablation (RFA).

Results

Of 983 patients, 221 underwent PFA, 216 CBA, and 546 RFA. Procedure times were shorter with PFA (72 ± 30 minutes) compared with CBA (77 ± 27 minutes) and RFA (99 ± 23 minutes; P < .001). Extra–pulmonary vein ablation was performed in 74.2% PFA, 9.7% CBA, and 42.1% RFA (P < .001). The major complication rate was 1.01% (n = 10) and was not significantly different between groups (1 PFA, 2 CBA, and 7 RFA; P = .578). Minor complications were observed in 1.4% PFA, 5.1% CBA, and 3.5% RFA (P = .093). The 1-year atrial tachyarrhythmia freedom in the propensity score–matched population was 77.2% with PFA, 80.8% with CBA, and 74.9% with RFA; P = .52).

Conclusion

PFA is a safe and effective option for elderly patients, offering the advantage of enabling extra–pulmonary vein ablation without the concern of thermal injury risk.

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经Pentaspline多电极导管的老年人脉冲场消融：安全性、有效性以及与低温球囊和射频装置的比较。

背景：导管消融是治疗心房颤动（AF）的有效方法。脉冲场消融（PFA）是一种新型的能量方式，它依靠高压电场来实现心脏组织消融。关于它对老年人的疗效的数据很少。目的：探讨bb0 ~ 75岁患者PFA的手术细节及临床效果。方法：通过FarapulseTM系统，在6个大容量中心连续招募年龄在50 ~ 75岁之间的房颤患者进行PFA治疗。比较第二代冷冻球囊（CBA）和射频（RFA）消融患者的手术细节和临床结果。结果：983例患者中，221例行PFA， 216例行CBA， 546例行RFA。与CBA（77±27分钟）和RFA（99±23分钟）相比，PFA的手术时间（72±30分钟）更短（PFA为72±30分钟）。结论：PFA对于老年患者是一种安全有效的选择，其优点是可以进行pv外消融，而无需担心热损伤风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.