Background: Pulmonary vein isolation (PVI) using radiofrequency ablation is an established treatment option for patients with atrial fibrillation (AF). However, data about AF ablation with the novel HPSD in the elderly population is still warranted. Therefore, the aim of this study is to investigate the efficacy and safety of HPSD AF ablation in patients over 75 years compared to patients younger than 75 years. 

Methods: Consecutive patients >75 years with paroxysmal or persistent AF underwent first AF ablation using the 50W HPSD approach in one high-volume centre.  Data was compared to a control group including patients <75 years from our institutional database. Periprocedural parameters and complications were recorded and analysed. Short-term endpoints included intraprocedural reconnection of at least one PV after initial isolation and intrahospital AF recurrence; midterm endpoint AF freedom after 3 months, long-term endpoint AF freedom after 12 months. 

Results: A total of 540 patients underwent a first AF ablation with HPSD (66  10 years; 58% male; 47% paroxysmal AF). Mean age in the elderly group was 78  2.4 years and 63  6.3 years in the control group (p<0.001). Elderly patients were significantly more females (p=0.001). Procedure, fluoroscopy and ablation time were equal. Elderly patients revealed significantly more often extra-PV low voltage areas requiring additional LA ablation (p<0.001). Overall complication rates were low, however elderly patients required significantly more often postinterventional pacemaker implantations due to sinus arrest or higher degree AV block (p=0.003). All other complication rates were equally distributed. Acute and short-term success rates (intraprocedural PV reconnection, intrahospital AF recurrences and sinus rhythm at 3 months) were equal among both groups (all p>0.05). On the other hand, elderly patients, especially with paroxysmal AF revealed significantly more often AF recurrences after 12 months (61% vs. 72%; p=0.054). However, this could not be confirmed via multivariable regression models, where only female gender was associated with AF recurrence after 12 months (OR 1.764, CI 1.077 – 2.890, p=0.024), but not age >75 years.

Conclusions: Our data confirm the efficacy and safety of HPSD ablation as an AF treatment option in elderly patients with almost similar complication and success rates when compared to a younger control group. The increased AF recurrences among elderly patients seem to be driven by female patients.