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

HRMC Investigators; Kazutaka Nakasone; Domenico G Della Rocca; Michele Magnocavallo; Andres Betancur; Giampaolo Vetta; Luigi Pannone; Antonio Sorgente; Charles Audiat; Jesus Rodriguez; Ioannis Doundoulakis; Andrija Nekic; Vedran Velagić; Marco Polselli; Sanghamitra Mohanty; Lorenzo Marcon; Juan Sieira; Erwin Ströker; Gezim Bala; Stefano Bianchi; Alexandre Almorad; Stephane Combes; Dimitrios Tsiachris; Andrea Sarkozy; Andrea Natale; Serge Boveda; Pietro Rossi; Carlo de Asmundis; Gian-Battista Chierchia

doi:10.1016/j.hrthm.2025.01.025

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

HRMC Investigators , Kazutaka Nakasone, Domenico G Della Rocca, Michele Magnocavallo, Andres Betancur, Giampaolo Vetta, Luigi Pannone, Antonio Sorgente, Charles Audiat, Jesus Rodriguez, Ioannis Doundoulakis, Andrija Nekic, Vedran Velagić, Marco Polselli, Sanghamitra Mohanty, Lorenzo Marcon, Juan Sieira, Erwin Ströker, Gezim Bala, Stefano BianchiAlexandre Almorad, Stephane Combes, Dimitrios Tsiachris, Andrea Sarkozy, Andrea Natale, Serge Boveda, Pietro Rossi, Carlo de Asmundis, Gian-Battista Chierchia

Onderzoeksoutput: Article › peer review

Samenvatting

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.

Originele taal-2	English
Aantal pagina's	10
Tijdschrift	Heart Rhythm
DOI's	https://doi.org/10.1016/j.hrthm.2025.01.025
Status	Published - 24 jan 2025

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10.1016/j.hrthm.2025.01.025

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HRMC Investigators , Nakasone, K., Della Rocca, D. G., Magnocavallo, M., Betancur, A., Vetta, G., Pannone, L., Sorgente, A., Audiat, C., Rodriguez, J., Doundoulakis, I., Nekic, A., Velagić, V., Polselli, M., Mohanty, S., Marcon, L., Sieira, J., Ströker, E., Bala, G., ... Chierchia, G-B. (2025). Pulsed field ablation in the elderly by a pentaspline multielectrode catheter: Safety, efficacy, and comparison with cryoballoon and radiofrequency devices. Heart Rhythm. https://doi.org/10.1016/j.hrthm.2025.01.025

HRMC Investigators ; Nakasone, Kazutaka ; Della Rocca, Domenico G ; Magnocavallo, Michele ; Betancur, Andres ; Vetta, Giampaolo ; Pannone, Luigi ; Sorgente, Antonio ; Audiat, Charles ; Rodriguez, Jesus ; Doundoulakis, Ioannis ; Nekic, Andrija ; Velagić, Vedran ; Polselli, Marco ; Mohanty, Sanghamitra ; Marcon, Lorenzo ; Sieira, Juan ; Ströker, Erwin ; Bala, Gezim ; Bianchi, Stefano ; Almorad, Alexandre ; Combes, Stephane ; Tsiachris, Dimitrios ; Sarkozy, Andrea ; Natale, Andrea ; Boveda, Serge ; Rossi, Pietro ; de Asmundis, Carlo ; Chierchia, Gian-Battista. / Pulsed field ablation in the elderly by a pentaspline multielectrode catheter : Safety, efficacy, and comparison with cryoballoon and radiofrequency devices. In: Heart Rhythm. 2025.

@article{e2a79678601942828992f102ca2f3c42,

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

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.",

author = "{HRMC Investigators} and Kazutaka Nakasone and {Della Rocca}, {Domenico G} and Michele Magnocavallo and Andres Betancur and Giampaolo Vetta and Luigi Pannone and Antonio Sorgente and Charles Audiat and Jesus Rodriguez and Ioannis Doundoulakis and Andrija Nekic and Vedran Velagi{\'c} and Marco Polselli and Sanghamitra Mohanty and Lorenzo Marcon and Juan Sieira and Erwin Str{\"o}ker and Gezim Bala and Stefano Bianchi and Alexandre Almorad and Stephane Combes and Dimitrios Tsiachris and Andrea Sarkozy and Andrea Natale and Serge Boveda and Pietro Rossi and {de Asmundis}, Carlo and Gian-Battista Chierchia",

year = "2025",

month = jan,

day = "24",

doi = "10.1016/j.hrthm.2025.01.025",

language = "English",

journal = "Heart Rhythm",

issn = "1547-5271",

publisher = "Elsevier",

}

HRMC Investigators , Nakasone, K, Della Rocca, DG, Magnocavallo, M, Betancur, A, Vetta, G , Pannone, L , Sorgente, A , Audiat, C, Rodriguez, J, Doundoulakis, I, Nekic, A, Velagić, V, Polselli, M, Mohanty, S, Marcon, L , Sieira, J , Ströker, E , Bala, G, Bianchi, S, Almorad, A, Combes, S, Tsiachris, D, Sarkozy, A, Natale, A, Boveda, S, Rossi, P, de Asmundis, C & Chierchia, G-B 2025, 'Pulsed field ablation in the elderly by a pentaspline multielectrode catheter: Safety, efficacy, and comparison with cryoballoon and radiofrequency devices', Heart Rhythm. https://doi.org/10.1016/j.hrthm.2025.01.025

Pulsed field ablation in the elderly by a pentaspline multielectrode catheter : Safety, efficacy, and comparison with cryoballoon and radiofrequency devices. / HRMC Investigators ; Nakasone, Kazutaka; Della Rocca, Domenico G; Magnocavallo, Michele; Betancur, Andres; Vetta, Giampaolo ; Pannone, Luigi ; Sorgente, Antonio ; Audiat, Charles; Rodriguez, Jesus; Doundoulakis, Ioannis; Nekic, Andrija; Velagić, Vedran; Polselli, Marco; Mohanty, Sanghamitra; Marcon, Lorenzo ; Sieira, Juan ; Ströker, Erwin ; Bala, Gezim; Bianchi, Stefano; Almorad, Alexandre; Combes, Stephane; Tsiachris, Dimitrios; Sarkozy, Andrea; Natale, Andrea; Boveda, Serge; Rossi, Pietro; de Asmundis, Carlo ; Chierchia, Gian-Battista.

In: Heart Rhythm, 24.01.2025.

Onderzoeksoutput: Article › peer review

TY - JOUR

T1 - Pulsed field ablation in the elderly by a pentaspline multielectrode catheter

T2 - Safety, efficacy, and comparison with cryoballoon and radiofrequency devices

AU - HRMC Investigators

AU - Nakasone, Kazutaka

AU - Della Rocca, Domenico G

AU - Magnocavallo, Michele

AU - Betancur, Andres

AU - Vetta, Giampaolo

AU - Pannone, Luigi

AU - Sorgente, Antonio

AU - Audiat, Charles

AU - Rodriguez, Jesus

AU - Doundoulakis, Ioannis

AU - Nekic, Andrija

AU - Velagić, Vedran

AU - Polselli, Marco

AU - Mohanty, Sanghamitra

AU - Marcon, Lorenzo

AU - Sieira, Juan

AU - Ströker, Erwin

AU - Bala, Gezim

AU - Bianchi, Stefano

AU - Almorad, Alexandre

AU - Combes, Stephane

AU - Tsiachris, Dimitrios

AU - Sarkozy, Andrea

AU - Natale, Andrea

AU - Boveda, Serge

AU - Rossi, Pietro

AU - de Asmundis, Carlo

AU - Chierchia, Gian-Battista

PY - 2025/1/24

Y1 - 2025/1/24

N2 - 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.

AB - 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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U2 - 10.1016/j.hrthm.2025.01.025

DO - 10.1016/j.hrthm.2025.01.025

M3 - Article

C2 - 39864479

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

ER -