Atrial Fibrillation in the Young: Catheter Ablation Efficacy Investigated in a Propensity-Score Matched Cohort.

Introduction: The pathophysiological substrate of young-onset atrial fibrillation (yAF) is diverse, involving both genetic predisposition and an increasing burden of cardiovascular risk factors among younger populations. Despite its growing clinical relevance, the available literature on the role of catheter ablation (CA) in yAF remains limited. The aim of the present study was to assess the efficacy of CA in a cohort of patients with yAF undergoing first time CA.

Methods and results: This was a single-center retrospective study. Patients with yAF (aged ≤ 45 years) who underwent first-time CA were compared against a 1:1 propensity-score matched cohort of older patients (> 45years), to assess arrhythmia recurrences in a follow-up period of 12-month. Logistic regression was used to compare differences with calculation of odds ratios (OR) with 95% confidence intervals (CI). 225/450 (50%) patients were included in the yAF group and 225/450 (50%) in the older group. The mean age in the yAF group was 39 ± 6 years [vs. 58 ± 7 in the older group], 76% were males and 79% had paroxysmal type of AF. The types of CA were radiofrequency (54%), cryoablation (44%), and pulsed field ablation (2.7%). Patients in the older group experienced significantly more arrythmia recurrences (63/225 [28%] vs 40/225 [18%], OR = 1.80, 95%CI = [1.15, 2.83], p = 0.01) in the 12-month follow-up period. In the initial (unmatched) cohort, age was significantly and linearly associated with AF recurrences at 12 months [OR = 1.02, 95%CI = (1,1.04), p = 0.025], with the Youden index maximizing at 59 years.

Conclusions: In this propensity score matched cohort study, younger patients (≤ 45 years) with AF who underwent first-time CA, experienced significantly less arrhythmia recurrences in a 12-month follow-up period, off antiarrhythmic drugs compared to older individuals. Complication rates did not differ between groups. No association was found between the type of CA and the risk of recurrence.