ABSTRACT Background Vascular access and postprocedural access site management remain the leading causes for postprocedural complications following interventional electrophysiological (EP) procedures. Method Patients were consecutively included in a prospective registry (TRUST, NCT05521451). Two vascular access and groin‐site management protocols that changed as an institutional standard at a cut‐off date (August 15, 2022) were compared. Group I used conventional access with an 8‐h pressure bandage and bed rest. Group II utilized ultrasound‐guided access, figure‐of‐8 suture, a 2‐h pressure bandage, and 6 h total bed rest. Minor complications included hematoma, bleeding, AV fistula, or pseudoaneurysm not requiring intervention. Major complications involved any incident necessitating intervention (transfusion, surgery, interventional therapy) or retroperitoneal hematoma. Results A total of 1672 procedures in 1501 patients (median age 65 (IQR 56.74) years, 38% female) were analyzed. Clinical features were balanced with the exception of a higher body mass index (median 27 [24;31] vs. 26 [24;30], p = 0.011) and more frequent arterial hypertension (63% vs. 56%, p = 0.003) in Group I. Total vascular complication rate was 9% (69/780 procedures) for Group I, and 4% (40/892 procedures) for Group II (OR 0.48 [95% CI: 0.32–0.73], p < 0.001). Major complications occurred in 30/109 (28%) cases, of which 20/780 (3%) occurred in Group I and 10/892 (1%) in Group II (OR 0.43 [95% CI: 0.18–0.97], p = 0.042). Hematomata were most frequently observed in both groups (Group I: 46/69, 67%; Group II: 30/40, 75%). Conclusion Vascular complication rates in EP‐procedures were significantly reduced by implementing a novel institutional groin‐site management standard including ultrasound‐guided vascular access and modified post‐interventional care.

Das aktualisierte Positionspapier der DGK zur Katheterablation von Vorhofflimmern (AF) [1] stellt die aktuelle Evidenz, Techniken und Qualitätsstandards dar, die sich seit 2017 gemeinsam mit Indikation, Technik und Rolle der Ablation in der Therapie deutlich gewandelt haben. Die Pulmonalvenenisolation (PVI) bleibt zentraler Bestandteil der AF-Ablation. Neben etablierten Verfahren wie Radiofrequenz- und Kryoablation gewinnt die Pulsed-Field-Ablation (PFA) an Bedeutung. Bei persistierendem AF fehlen klare Empfehlungen über die PVI hinaus, trotz zunehmender Daten für ergänzende Ablationsstrategien. Die Versorgungssituation zeigt eine starke Zunahme der Ablationen, wobei die tagesgleiche Entlassung nur für selektierte Patienten empfohlen wird. Die präzise Patientenselektion, inklusive Anamnese, Risikofaktoren und Bildgebung sind entscheidend für den Erfolg und die Sicherheit. Die Bedeutung von periprozeduralem Management und strukturierter Nachsorge wird hervorgehoben. Komplikationen wie Perikardtamponade, Schlaganfall und Phrenikusparese erfordern strukturierte Abläufe und erfahrene Teams. Besonders bei Patienten mit Herzinsuffizienz zeigt sich die Ablation als potenziell prognoseverbessernd. Die Zertifizierung von Zentren durch die DGK dient der Qualitätssicherung. Neue Entwicklungen wie KI-gestützte Ablationsplanung und Studien zur OAK-Strategie nach Ablation werden die Praxis weiter verändern.

BACKGROUND:Atrial fibrillation (AF) increases cardiovascular risk in patients with chronic kidney disease (CKD). The safety and efficacy of early rhythm control (ERC) in patients with CKD is not fully established. OBJECTIVES:This predefined secondary analysis of the EAST-AFNET 4 trial assessed the effectiveness and safety of ERC in patients with CKD defined by estimated glomerular filtration rate (GFR). METHODS:EAST-AFNET 4 randomized patients with recently diagnosed AF and comorbidities to ERC or usual care (UC). Key outcomes were analyzed by Kidney Disease Improving Global Outcomes defined CKD groups. The primary efficacy outcome combined cardiovascular death, stroke, hospitalization for worsening heart failure, or acute coronary syndrome. The safety outcome combined death, stroke, and serious rhythm control-related adverse events. Recurrent AF was a secondary outcome. RESULTS:Baseline creatinine was available in 2,742 of 2,789 (98.3%) patients. In this study, 23% had CKD (GFR: <60 mL/min/1.73 m2). Patients with CKD were older (CKD: 74 ± 7.4 years; no CKD: 69 ± 8.3 years; P < 0.001), had higher CHA2DS2-VASc scores (CKD: 4 ± 1.4; no CKD: 3.2 ± 1.2; P < 0.001), and more primary outcome events over 5.1 years of follow-up (HR: 0.98 per mL GFR decrease [95% CI: 0.97-0.99 per mL GFR decrease]). ERC reduced the primary outcome with and without CKD (no CKD: ERC: 3.4%/100 patient-years; UC: 4.1%/100 patient-years; HR: 0.84; P < 0.001; CKD: ERC: 5.8%/100 patient-years; UC: 8.5%/100 patient-years; HR: 0.67; P < 0.001; Pinteraction = 0.133). CKD increased safety outcomes without interaction with ERC (Pinteraction = 0.927). Patients with CKD experienced more AF recurrences with UC (Pinteraction = 0.036). CONCLUSION:ERC effectively and safely reduces cardiovascular events in patients with recently diagnosed AF and stroke risk factors with and without CKD. (Early Treatment of Atrial Fibrillation for Stroke Prevention Trial (EAST); NCT01288352).

Background Fasciculoventricular pathways (FVPs) are variants of pre-excitation syndrome with uncertain prevalence in the human heart. This case report presents findings from an invasive electrophysiological study (EPS) that mostly fulfil the established diagnostic criteria for FVP, but also exhibit atypical features, highlighting diagnostic ambiguity in clinical practice.Case summary A 23-year-old patient presented with a history of brief, weekly episodes of palpitations. The resting surface ECG demonstrated a pre-excitation pattern suggestive of either a parahisian or fasciculoventricular pathway. The EPS findings were largely consistent with a FVP. During junctional beats, we observed a loss of pre-excitation and normalization of HV-interval. No tachycardia was inducible, and there was no evidence of retrograde conduction via an accessory pathway.Discussion Three potential anatomical locations of the upper FVP take-off side were considered: (i) a single FVP originating from the lower part of the His-bundle or (ii) a single FVP originating close to the upper, junctional part of the His-bundle or even from the distal part of the AV-node and (iii) the presence of an additional second accessory pathway. Based on the above-mentioned evidence, the second anatomical location of the upper FVP-insertion was most likely, differing from previous findings of FVP in the literature. A conservative, observational management strategy was adopted. Current diagnostic criteria for FVP are based on retrospective studies and case reports, lacking prospective validation. This case underscores the need for further research to refine the diagnostic approach to FVP and improve risk stratification in such patients.

Background Atrial fibrillation (AF) is common in hypertrophic cardiomyopathy (HCM) and increases stroke risk, primarily due to thromboembolism from the left atrial appendage (LAA). Oral anticoagulation (OAC) is recommended, but data on LAA thrombus (LAAT) in HCM and AF are limited. The current study aimed to assess LAAT prevalence in patients with HCM and AF. Methods We retrospectively analyzed 170 patients with HCM and AF (mean age, 67.7±12.4 years; 57.1% men) who underwent at least one transesophageal echocardiogram (TEE) during a median follow‐up of 41.5 months (interquartile range, 15–77 months). Results At the time of TEE, 147 (86.5%) patients were undergoing OAC, with 52 (30.6%) taking vitamin K antagonists and 95 (55.9%) taking non–vitamin K antagonist oral anticoagulants. LAAT was found in 36 patients (21.2%), with prevalence rates of 23.1% (n=12) in vitamin K antagonist users, 16.8% (n=16) in non–vitamin K antagonist oral anticoagulant users, and 34.8% (n=8) in those without OAC. Non–vitamin K antagonist oral anticoagulant use was associated with a significant LAAT risk reduction compared with no OAC (odds ratio, 0.20 [95% CI, 0.05–0.73]; P =0.02). Decreased LAA flow velocity ( P <0.001) was independently linked to LAAT. Conclusions LAAT is common in patients with HCM and AF, even among those receiving OAC. Reduced LAA flow velocity may increase thrombus risk. TEE should be considered before rhythm‐control strategies, even in patients with HCM receiving anticoagulation, to minimize thromboembolic complications.

Aims Optimal outcomes for patients with cardiac arrhythmias can be achieved through multimodal therapy including lifestyle support, medication, and interventions. Planning of these therapy concepts requires a detailed understanding of phenotypes, responses to therapies, and outcomes.Objective The prospective Long-term Outcome and Predictors for Recurrence after Medical and Interventional Treatment of Arrhythmias at the University Heart Center Hamburg (TRUST) combines deep phenotypic, procedural, and follow-up information in a contemporary cohort of patients with cardiac arrhythmias.Methods and results TRUST is an investigator-initiated, prospective, cohort study enrolling consecutive patients at the UHZ Hamburg. Comprehensive baseline work-up, imaging, and biobanking at baseline is combined with follow-up using a combination of in-person visits, online questionnaires, and remote rhythm-monitoring. Enrolment started in March 2021 and is ongoing. This paper describes the design and the clinical characteristics of the first 1500 enrolled patients with verified baseline datasets (562 women (37%), median age 64 (IQR 55, 74) years). Overall, 1077/1500 patients (71%) were seen for atrial fibrillation, 161/1500 (11%) for ventricular tachycardia and premature ventricular complexes, 239/1500 (16%) for supraventricular tachycardia, and 23/1500 (2%) patients for other reasons. Ablations, rhythm surgery, or invasive procedures were performed in 1363/1500 (91%) within 1 month after inclusion.Conclusion This snapshot of the first 1500 patients enrolled in TRUST illustrates current characteristics and comorbidity burden in patients undergoing arrhythmia treatment. This rich data set will provide information on treatment patterns, detailed phenotypes, and follow-up, offering insights into the natural progression and treatment responses of arrhythmias in routine care.

The updated German Society of Cardiology (DGK) position paper on catheter ablation of atrial fibrillation (AF) [1] presents the current evidence, techniques, and quality standards, which have evolved significantly since 2017 alongside indications, technology, and the role of ablation in therapy. Pulmonary vein isolation (PVI) remains the cornerstone of AF ablation. In addition to established procedures such as radiofrequency and cryoballoon ablation, pulsed field ablation (PFA) is gaining importance. For persistent AF, clear recommendations beyond PVI are still lacking, despite growing evidence supporting adjunctive ablation strategies. The healthcare landscape shows a marked increase in ablations, with same day discharge procedures recommended only for carefully selected patients. Precise patient selection-including medical history, risk factors, and imaging-is critical for procedural success and safety. The importance of periprocedural management and structured follow-up is emphasized. Complications such as pericardial tamponade, stroke, and phrenic nerve injury require structured protocols and experienced teams. Particularly in patients with heart failure, ablation may offer prognostic benefits. Certification of centers by the DGK supports quality assurance. New developments, such as artificial intelligence (AI)-assisted ablation planning and studies on postablation anticoagulation strategies, are expected to further influence clinical practice.

Abstract Background Deep sedation has been shown to be safe and feasible for the pentaspline (ps) PFA system. Skeletal muscle, phrenic nerve stimulation, and esophageal contraction have caused discussions about sedation protocols when PFA is performed in deep sedation, but data remain scarce. Objective To compare the doses of sedation and analgesia and evaluate safety of deep sedation during index PVI using cryoballoon (CB) and psPFA. Methods Patients undergoing index PVI were consecutively enrolled into TRUST, a prospective, single-center, clinical cohort study. Sedation was initiated using a bolus of 0.5mg/kg propofol and 25µg fentanyl, and maintained using continuous propofol administration at 6-7mg/(kg*min). Additional boli or higher propofol rates were applied at the discretion of the operator when sedation depth or analgesia were deemed insufficient. To account for procedure time and patient weight, propofol and fentanyl doses were indexed to both of these parameters (mg/(kg*min); ng/(kg*min)). Results In total, 375 patients (192 CB, 183 psPFA) were included. Patient characteristics are displayed in the Figure. In the psPFA group, fentanyl doses were significantly higher than in the CB group (7.39±4.80 ng/(kg*min) vs. 6.38±3.54 ng/(kg*min); p=0.025). There was no difference in propofol doses between the groups (0.14±0.08 mg/(kg*min) vs. 0.13±0.05 mg/(kg*min); p=0.24). Sedation-related adverse events were rare: Intraprocedural pulmonary aspiration occurred in 2/183 patients (1.1%) from the psPFA group, one of which required intermittent bag ventilation (1/183; 0.5%). Both patients were treated with antibiotics prophylactically and did not develop pneumonia. In both cases, the hospital stay was not prolonged due to pulmonary aspiration. No sedation-related complications occurred in the CB-group. Conclusion Pulsed-field ablation with deep sedation is safe and feasible in this series. Higher opioid doses during psPFA procedures suggest an increased need for analgesia, potentially to mitigate pain from energy delivery or skeletal muscle activation. Monitoring for signs of intraprocedural pulmonary aspiration during PFA procedures could further reduce sedation-related risks during PFA ablation.

BACKGROUND AND AIMS:Population aging is increasing atrial fibrillation (AF) prevalence. In elderly patients with persistent AF, pulmonary-vein isolation (PVI) has limited success, but is widely used. Pacemaker-implantation with atrioventricular-node ablation (PM+AVNA) provides effective symptom control, but the relative effects of PM+AVNA versus PVI on hospitalisations and other outcomes in the elderly remain unknown. METHODS:This investigator-initiated, multicentre, open-label trial randomised patients aged≥75 years with symptomatic persistent AF and normal left-ventricular ejection fraction to PM+AVNA or PVI treatment-strategies. The primary endpoint was a composite of hospitalisation for atrial arrhythmia or heart failure, outpatient electrical cardioversion or upgrade to cardiac resynchronisation therapy for left-ventricular dysfunction. Secondary endpoints included all-cause death, stroke, treatment-related complications and quality of life. RESULTS:Twelve centres in Germany and Austria randomised 196 patients (median age 82 years). At 12 months, a first primary endpoint event occurred in 24 of 98 patients (24%) assigned to PM+AVNA and 45 of 98 patients (46%) assigned to PVI (hazard ratio 0.45, 95% confidence interval 0.27 to 0.74; P=0.002). A total of 29 and 84 primary endpoint events occurred respectively, consisting principally of AF-hospitalisations and cardioversions in the PVI group (54 and 19 respectively, vs 3 and 1 in PM+AVNA group) and of heart failure-hospitalisations in the PM+AVNA Group (23, vs 11 in PVI group). The incidence of cardiovascular complications and mortality, as well as qualityof-life, were not statistically different. CONCLUSIONS:In elderly patients with persistent AF, PM+AVNA was associated with fewer primary endpoint events than PVI over a 12-month follow-up period.

The updated position paper of the German Cardiac Society (DGK) on catheter ablation of atrial fibrillation (AF) presents the current evidence, techniques and quality standards, which have clearly evolved since 2017 together with the indications, techniques and the role of ablation in treatment. Pulmonary vein isolation (PVI) remains the cornerstone of AF ablation. In addition to established procedures, such as radiofrequency and cryoballoon ablation, pulsed field ablation (PFA) is gaining in importance. For persistent AF clear recommendations beyond PVI are lacking, despite growing evidence supporting adjunctive ablation strategies. The healthcare landscape shows a marked increase in ablation, with same day discharge procedures recommended only for carefully selected patients. Precise patient selection, including medical history, risk factors and imaging, is critical for procedural success and safety. The importance of periprocedural management and structured follow-up is emphasized. Complications such as pericardial tamponade, stroke and phrenic nerve paresis require structured protocols and experienced teams. Ablation can potentially improve the prognosis, particularly in patients with heart failure. Certification of centers by the DGK supports quality assurance. New developments, such as artificial intelligence (AI)-assisted ablation planning and studies on postablation oral anticoagulation strategies, are expected to further influence clinical practice.

A novel lattice-tip combined mapping and ablation catheter, capable of pulsed-field (PFA) and conventional radiofrequency (RF) ablation and fully integrated into a novel mapping and ablation platform, has been introduced. Information on long-term outcomes for a range of clinically used left and right atrial ablation targets is not yet fully available. Consecutive patients undergoing first-time AF ablation using the new system at our center and with one-year follow-up were collected and analysed. AF ablation consisted of PFA-based pulmonary vein isolation and, based at the clinician's discretion, additional linear lesions (RF or PFA). All patients provided written informed consent and were enrolled in our prospective TRUST Registry. A total of 32 patients were analysed (11/32 (34%) women, median age 67.5 years (61.2–74.5), 16/32 (50%) persistent AF (Pers-AF), median left ventricular ejection fraction (LVEF) 60% (50.7–60)). Acute PVI with PFA only was achieved in 32/32 (100%) PVs with first pass isolation in 125/125 (100%) PVs. Median mapping time was 22.5 (16–28.2) minutes. Additional left atrial linear lesions were delivered in 19/32 (59%) patients, including 6 anterior lines (RF+PFA), 3 mitral isthmus lines (2/3 (66.6%) RF and 1/3 (33.3%) RF+PFA), 11 roof lines (PFA), and 1 posterior box (PFA). In 7/32 (21.9%) patients, cavo-tricuspid isthmus ablation was performed after documentation of typical atrial flutter. All the linear lesion sets were bidirectionally blocked at the end of the procedure. Mean procedure and fluoroscopy times were 100.8 ± 25.4 and 8.6 ± 3.8 minutes, respectively. Mean dose area product was 518.2 ± 433.9 cGycm2. Cumulative median ablation time was 5.85 (4.88–7.06) minutes and median number of lesions was 93.5 (78.5–105.2). Ablation-related complications occurred in 1/32 (3%) patients (1 cardiac tamponade). AF free survival after a median FU of 341 (236–360) days was 82.9% for paroxysmal AF (PAF) and 67.5% for Pers-AF (p value = 0.62). Large focal-tip catheter-based ablation for AF appears safe and effective for a range of left and right atrial ablation targets with good rhythm outcomes at one-year follow-up.

Background: Achieving early rhythm control and maintaining sinus rhythm are associated with improved outcomes in patients with atrial fibrillation (AF). Pulmonary vein isolation (PVI) is a validated alternative to medical rhythm control. This study determined associations between left atrial strain reservoir (LASR) and AF recurrence after PVI. Methods and Results: In all, 132 patients (88 with paroxysmal AF [PAF], 44 with persisting AF [PersAF]) who presented in sinus rhythm for de novo PVI of AF between December 2017 and January 2019 were included in the study. All patients underwent pre- procedural echocardiography. After 12 months, all patients underwent 24-h Holter electrocardiogram monitoring to screen for AF recurrence. Kaplan-Meier curve analysis revealed an association between decreasing LASR and increased AF recurrence, with a cut-off at 31.4%. In univariable Cox regression analysis, LASR demonstrated an association with AF recurrence, with hazard ratios (HR) of 0.83 (95% confidence interval [CI] 073-0.93; P=0.001) per 5% increase in univariable models and 0.83 (95% CI 073-0.95; P=0.005) in multivariable analysis. When clinical variables with age, sex and type of AF (PAF/PersAF) were included in the multivariable analysis, LASR remained relevant in a model with age (HR 0.86; 95% CI 073-1.00; P=0.046). Conclusions: In patients undergoing de novo PVI for AF, LASR could be of use in risk stratification regarding AF recurrence.

Concerns exist about the safety of amiodarone and dronedarone. We assessed the long-term outcome of both drugs for early rhythm control (ERC) in the EAST-AFNET 4 trial. Patients randomized for ERC and treated with amiodarone or dronedarone were compared to other ERC-therapies. Patients receiving amiodarone or dronedarone at initial therapy (n = 653/1395) were older with more comorbidities and less paroxysmal atrial fibrillation (AF, 29

Background Transseptal puncture (TSP) is critical for atrial fibrillation (AF) ablation. However, patients with atrial septal occluders (ASOs) for atrial septal defects (ASDs) or persistent foramen ovale (PFO) pose unique challenges. Objective This study aimed to evaluate the peri- and postprocedural safety, AF recurrence, and incidence of newly developed ASD/PFO up to 12 months postprocedure. Methods This multicenter, prospective observational study included 59 patients (mean age 61.2 ± 12.1 years, 56% male) with drug-refractory AF who underwent pulmonary vein isolation (PVI) between 2019 and 2024. Of these patients, 38 had ASDs and 21 had PFOs, with ASOs in situ. All punctures (single TSP) were performed under fluoroscopic guidance. Results The majority of TSP positions in the interatrial septum related to the ASO was inferior-posterior to the ASO (66.1%) or inferior-anterior (23.7%). In case of failure of the inferior part, puncture was performed in superior-posterior puncture (8.5%) or puncture through the occluder (1.7%). Mean ablation time was 14.9 ± 8.4 minutes, including radiofrequency (83.0%), cryoballoon (11.9%), and pulsed field ablation (5.1%). No major complications were observed, except for 1 transient phrenic nerve palsy during cryoballoon ablation, which recovered intraprocedurally. Voltage mapping revealed no additional substrate related to the occluder. During 12-month follow-up, 7 patients (11.9%) experienced AF recurrence. Conclusion TSP and PVI are safe and can be safely performed in patients with an ASO. No additional substrate related to the occluder was seen. Although no direct comparison was made, outcomes align with existing literature. Further studies are needed.

Atrial fibrillation (AF) is a growing unmet medical need. To reduce its impact on patients' lives, improvements in stroke prevention therapy, treatment of concomitant conditions, and rhythm control therapy are actively developed: Innovations in anti-thrombotic agents, new anti-arrhythmic drugs (AADs), and novel interventional rhythm control therapies emerge alongside AF-reducing effects of general cardiometabolic therapies. Simple risk scores are slowly replaced by personalized AF risk estimation using quantifiable features. These developments were discussed by over 80 experts from academia and industry during the 10th Atrial Fibrillation NETwork /European Heart Rhythm Association consensus conference from 5 to 7 May 2025. The emerging consensus, described here, is multi-domain therapy combining stroke prevention, rhythm control, and therapy of concomitant cardiovascular conditions. This combines anti-coagulants, AADs, and AF ablation with old and new cardiometabolic drugs that can reduce AF risk, AF burden, and AF-related complications at scale. The paper furthermore describes quantitative traits that may enable a shift towards risk-driven therapy based on AF phenotypes. These can enable adjusted therapy strategies that are safe, accessible, and patient-centred. Applying modern data science and artificial intelligence methods to quantitative phenotypic and genetic features can further improve risk estimation and personalized therapy selection. At the same time, translational and clinical research into reversing the drivers of AF and into improved stroke prevention through new drugs and through combination therapies is needed. Together, these efforts offer pathways towards personalized, patient-centred, multi-modal, and accessible AF management that integrates rhythm control, stroke prevention, and therapy of concomitant conditions to bridge today's practical needs with tomorrow's therapeutic innovation.

Atrial fibrillation ablation is an established procedure for the treatment of atrial fibrillation, in which Pulsed Field Ablation (PFA) is a novel method alongside radiofrequency and cryoablation. The article explains the technical basics of PFA, describes different types of catheters and gives detailed instructions on how to perform the procedure, from patient selection to sedation strategies and imaging. Important safety aspects and possible complications are also covered. Finally, the further development of PFA technology for the treatment of other arrhythmias and integration into 3D mapping systems is discussed. This work is part of a series of articles on further training in special rhythmology.

BACKGROUND:Catheter ablation is an established treatment for cardiac arrhythmia. There is a lack of data on invasive electrophysiological (EP) procedures in aged patients. METHODS:Consecutive patients ≥ 80 years who underwent catheter ablation or left atrial appendage closure procedures between January 2005 and December 2017 in a high-volume center were retrospectively studied and compared to a matched control group of individuals < 80 years of age. RESULTS:The aged group consisted of 486 patients who underwent 566 procedures at a mean age of 82.7 ± 2.5 years (range 80-95 years). A cohort of 480 patients aged < 80 years (mean age 64.1 ± 13.3 years) with 566 procedures served as a control group. Performed procedures were atrial arrhythmia ablation including atrial fibrillation treatment (n = 366, 64.7%), cavotricuspid isthmus ablation (n = 139, 24.6%), ablation of ventricular arrhythmias (n = 57, 10.1%), and left atrial appendage closure (n = 12, 2.1%). There were numerically more procedures with major complications after treatment of elderly patients (32 [5.7%] vs. 21 [3.5%] procedures, p = 0.12), as well as numerically more procedures accompanied by intrahospital deaths (6 [1.1%] vs. 1 [0.2%] procedure, p = 0.12). The rate of minor complications was significantly higher in aged patients as compared to younger controls (31 [5.1%] vs. 17 [20%] procedures, p = 0.039). CONCLUSION:Invasive EP procedures in octogenarians and nonagenarians are feasible, however a significantly higher incidence of minor periprocedural complications and a trend toward more severe complications and intrahospital fatalities were observed compared to younger patients. These findings support an individual risk-benefit assessment for elderly individuals before invasive EP treatments are conducted.