Abstract Body (Do not enter title and authors here): Background
Pulsed field ablation (PFA) for atrial fibrillation (AF) has demonstrated comparable treatment efficacy with conventional thermal ablation. Despite its high safety profile and increasing adoption worldwide, little is known about the real-world data on the efficacy and safety of PFA in elderly AF patients.

Methods
We conducted a retrospective observational study of patients with AF who underwent PFA with a pentaspline catheter (Farapulse, Boston Scientific). Patients were categorized into two groups: <80 years and ≥80 years, and baseline characteristics, procedural data, and recurrence of atrial arrhythmia were compared.

Results
Among the 483 AF patients enrolled in the study (mean age 69±11, male 66%), 76 (16%) patients were ≥80 years of age. The octogenarian group was characterized by proportionally more females, lower body mass index, and a higher prevalence of vascular disease and chronic kidney disease, with significantly higher CHA₂DS₂-VASc scores compared to the younger group (P<0.001). Compared to the younger patients, more octogenarians underwent adjunctive posterior wall (71% vs. 50%, P<0.001) and anterior wall (26% vs. 12%, P =0.002) ablation. Procedure time, ablation catheter dwell time, and fluoroscopy times were comparable between the two age groups. There were zero complications in the octogenarian group and 9 (2.2%) complications in the younger group (P=0.19). Early follow-up data (128±100 days) showed comparable rates of atrial arrhythmia recurrence between the octogenarian and younger patient groups.

Conclusions
PFA demonstrates acceptable efficacy and excellent safety in elderly patients aged ≥80 years despite a higher burden of comorbidities.