Long‐Term Outcome of Radiofrequency Versus Pulsed‐Field Ablation in Atrial Fibrillation Patients Aged More Than 60 Years Undergoing Their First Catheter Ablation

BACKGROUND: We evaluated the impact of pulsed-field (PFA) vs. radiofrequency ablation (RFA) on long-term ablation outcome in AF patients and whether the benefit was extended to all age groups, in a real-world population. METHODS: Consecutive AF patients undergoing their first ablation procedure were classified based on their age at baseline; group 1: > 60 years and group 2: ≤ 60 years. Each group were then subclassified based on the energy modality used; group 1A or 2A: received RFA, and group 1B or 2B: underwent PFA. All patients received isolation of PVs and left atrial posterior wall. RESULTS: A total of 1386 patients were included in group 1 (Gr 1A: 954; Gr 1B: 432) and 414 subjects in group 2 (Gr 2A: 284; Gr 2B: 130). Patients in group 1 were sicker with more comorbidities. At the end of 1-year follow-up, significantly higher recurrence rate was reported in group 1 patients receiving RFA compared to PFA (249 (26.1%) vs. 45 (10.4%), p < 0.001), whereas the recurrence rate was comparable between the two subgroups in group 2 (RFA: 69 (24.3%) vs. PFA: 22 (17%), p = 0.095). Mean time to recurrence was significantly longer in the Gr. 2B (PFA) population compared to RFA (7.21 ± 1.87 vs. 7.75 ± 2.03 months, p = 0.008) and comparable in Gr. 1 (RFA: 7.98 ± 1.29 vs. PFA: 8.12 ± 1.80 months, p = 0.531). After controlling for the variables in the multivariate model, PFA was associated with lower risk (OR = 0.378, 95% CI 0.265, 0.539; p-value < 0.001) and Persistent AF with higher risk of recurrence (OR = 1.745, 95% CI 1.562, 1.986; p-value = 0.040). CONCLUSION: PFA was associated with a significantly lower recurrence rate in patients > 60 years of age with more comorbidities compared to RFA. However, in patients aged ≤ 60 years, no difference in RFA vs. PFA in terms of recurrence rate was observed. Mean time to recurrence was comparable between PFA and RFA subgroups in the group 1 population, whereas it was significantly higher in group 2 PFA vs. RFA subgroup.