Introduction Catheter‐ablation (CA) of consecutive left atrial tachycardias (LAT) can be challenging. Pulsed field ablation (PFA) yields a novel nonthermal CA technology for treatment of atrial fibrillation (AF). There is no data regarding PFA of LAT. This study sought to investigate PFA of consecutive LAT following prior CA of AF. Methods Consecutive patients with LAT underwent ultrahigh‐density (UHDx) mapping. Subsequent to identification of the AT mechanism, PFA was performed at the assumed critical sites for LAT maintenance. Continuous ablation lines were performed if required and evaluated with pre‐ and post‐PFA HDx‐mapping. Results Fifteen patients (age 70 ± 10, male 73%) who underwent 3.6 ± 2 prior AF‐CA procedures were included. The total mean procedure and fluoroscopy times were 141 ± 43 and 18 ± 10 min, respectively. All 19 of 19 (100%) LAT were successfully ablated with PFA. Two AT located at the right atria required RF‐ablation. LAT were identified as localized reentry (n = 1) and macro‐reentry LAT (n = 18) and targeted with PFA. All LAT terminated with PFA either to sinus rhythm (9/15) or a secondary AT (6/15 and subsequently to SR); 63% (12/19) terminated with the first PFA‐application. All lines (13 roof, 11 anterior, 1 mitral) were blocked. LA‐posterior‐wall isolation (LAPWI) was successfully achieved when performed (10/10). AF/AT free survival was 80% (12/15) after 153 [88–207] days of follow‐up. No procedure‐related complications occurred. Conclusion PFA of consecutive LAT is feasible and safe. Successful creation of ablation lines and LAPWI can be achieved in a short time. PFA may offer the opportunity for effective ablation of atrial arrhythmias beyond AF.

Background The incidence and prevalence of atrial fibrillation (AF) increases with age. With an ageing general population, a 2.3-fold rise in AF prevalence is expected. Catheter ablation has emerged as an effective treatment option for rhythm control therapy. However, very elderly patients (≥80 years old) have been excluded in landmark clinical trials. Current data regarding the safety and efficacy of catheter ablation in the very elderly is therefore sparse. Purpose Due to the growing demand to manage AF in an increasingly ageing population, we investigated the safety and efficacy of catheter ablation in this particular patient population. Methods Patients with symptomatic paroxysmal, persistent and long-standing persistent AF aged ≥80 years undergoing catheter ablation, including first and re-ablation procedures in a single centre, were analysed retrospectively. Catheter ablation involved pulmonary vein isolation (PVI) using radiofrequency, cryoballoon and pulsed field ablation as energy sources. Re-ablation procedures included re-PVI and consecutive atrial tachycardia ablation including atrial lines and/or ablation of complex fractionated atrial electrograms (CFAE) in persistent AF. Endpoints included acute procedural success (complete isolation of pulmonary veins and/or non-inducibility in the case of atrial tachycardia), major complications and early arrhythmia-recurrence. Results A total of eighty-eight patients (mean age 83.1±1.9 years, mean CHA2DS2-VASc-Score 4.4±1, mean left ventricular ejection fraction 56.7±7%, direct oral anticoagulation 92.1%, vitamin-K antagonists 7.9%) were included from January 2021 to October 2021. Fifty cases (56.8%) involved PVI as an index procedure (radiofrequency 58%, n=29/50, cryoballoon 36%, n=18/50, pulsed field ablation 6%, n=3/50). Thirty-eight procedures (43.2%) involved re-ablation procedures (Re-PVI 60.5%, n=23/38, linear lesions 65.8%, n=25/38, atrial tachycardia ablation 26.3%, n=10/38 and ablation of CFAE 15.8%, n=6/38). Acute procedural success was achieved in 87/88 patients (98.9%). Major complications included stroke (n=1/88, 1.1%), pericardial tamponade (n=1/88, 1.1%) and bradycardia with subsequent pacemaker implantation (n=3/88, 3.4%). No further major complications were documented. In 13/88 patients (14.8%) early arrhythmia-recurrence occurred (38.5%, n=5/13 after the index procedure and 61.5%, n=8/13 after re-ablation) during the 90-day blanking period. Conclusions Catheter ablation for atrial fibrillation in the very elderly shows favourable acute success and low complication rates. Long term success of catheter ablation and superiority to rate control in this patient population is unknown and requires investigation in the future. Funding Acknowledgement Type of funding sources: None.

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