Our Summary

This study looked at the safety and effectiveness of a treatment called pulsed field ablation (PFA) for people over 80 with a heart condition called atrial fibrillation (AF). The researchers used data from a European registry of patients who had the treatment in seven different medical centers.

Out of 1233 patients in the registry, 88 were over 80 years old. These older patients were more often female, had a slightly lower body mass index (BMI), a higher risk of stroke (based on the CHA2DS2-VASc score), and a higher rate of high blood pressure. Regardless of age, most patients had a type of AF that comes and goes (paroxysmal AF).

Doctors more often performed the treatment with minimal interruption to blood thinning medication in the older group. Even though the overall rate of complications was similar in both age groups, the older patients had a slightly higher rate of stroke.

After one year, the rates of major adverse events and the percentage of patients who were free of irregular heart rhythm were similar in both age groups. None of the older patients who were free of irregular heart rhythm were on heart rhythm controlling medication at the end of the year.

In conclusion, this real-world data suggests that PFA is just as effective in older patients as it is in younger ones. However, older patients might have a slightly higher risk of stroke.

FAQs

  1. What is pulsed field ablation (PFA) and who were the subjects of this study?
  2. How did the rate of complications and effectiveness of the PFA treatment compare between the older and younger patient groups?
  3. Did the older patients who were free of irregular heart rhythm require heart rhythm controlling medication after the treatment?

Doctor’s Tip

A doctor might advise a patient considering cardiac ablation to discuss the potential risks and benefits with their healthcare provider, especially if they are over 80 years old. They may also recommend closely monitoring for signs of stroke after the procedure and making any necessary adjustments to medication. It’s important for patients to follow their doctor’s recommendations and attend follow-up appointments to ensure the best possible outcome.

Suitable For

Patients who are typically recommended cardiac ablation are those with atrial fibrillation (AF) that is not controlled with medication, those who have frequent episodes of AF, and those who have significant symptoms such as palpitations, shortness of breath, or fatigue. Additionally, patients who have tried other treatments for AF without success or who have a high risk of stroke may also be recommended for cardiac ablation. Older patients, such as those over 80 years old, may also be considered for cardiac ablation if they are otherwise healthy and fit for the procedure.

Timeline

Before cardiac ablation:

  • Patient undergoes various tests and evaluations to determine the need for cardiac ablation
  • Patient may be advised to stop certain medications or make lifestyle changes prior to the procedure
  • Patient meets with their cardiologist to discuss the procedure and potential risks and benefits
  • Patient schedules the cardiac ablation procedure and makes necessary arrangements
  • Patient undergoes the cardiac ablation procedure under sedation or general anesthesia
  • Patient is monitored in the hospital post-procedure for any complications

After cardiac ablation:

  • Patient is monitored closely for any complications or side effects post-procedure
  • Patient may experience some discomfort or soreness at the site of the catheter insertion
  • Patient is advised to avoid strenuous activities for a certain period of time
  • Patient may need to continue taking certain medications to prevent irregular heart rhythms
  • Patient follows up with their cardiologist for regular check-ups and monitoring of their heart rhythm
  • Patient may undergo additional tests or procedures if necessary to ensure the success of the cardiac ablation

Overall, the goal of cardiac ablation is to restore normal heart rhythm and improve the patient’s quality of life. It is important for patients to follow their doctor’s instructions and attend all follow-up appointments to ensure the best possible outcome.

What to Ask Your Doctor

Some questions a patient should ask their doctor about cardiac ablation, specifically pulsed field ablation for atrial fibrillation in older patients, include:

  1. What is pulsed field ablation and how does it differ from other types of cardiac ablation procedures?
  2. Is pulsed field ablation a suitable treatment option for my atrial fibrillation, especially considering my age and overall health?
  3. What are the potential risks and complications associated with pulsed field ablation, particularly for older patients?
  4. How does the rate of stroke risk compare for older patients undergoing pulsed field ablation compared to younger patients?
  5. What is the success rate of pulsed field ablation in older patients in terms of maintaining a regular heart rhythm and reducing symptoms of atrial fibrillation?
  6. How long does the recovery process typically take for older patients after undergoing pulsed field ablation?
  7. Are there any specific precautions or considerations that need to be taken into account for older patients undergoing pulsed field ablation?
  8. Will I need to continue taking medication for my atrial fibrillation after undergoing pulsed field ablation, and if so, for how long?
  9. How often will I need follow-up appointments and monitoring after the procedure?
  10. Are there any lifestyle changes or modifications that I should consider after undergoing pulsed field ablation as an older patient with atrial fibrillation?

Reference

Authors: Mené R, Sousonis V, Schmidt B, Bordignon S, Neven K, Reichlin T, Blaauw Y, Hansen J, Ouss A, Reinsch N, Mulder BA, Ruwald MH, van der Voort P, Kueffer T, Jacob S, Chun KRJ, Boveda S. Journal: Int J Cardiol. 2024 Dec 15;417:132522. doi: 10.1016/j.ijcard.2024.132522. Epub 2024 Sep 6. PMID: 39245073