Young Adults Benefit More From Catheter Ablation for AF

TOPLINE:

Young patients (≤ 45 years) with atrial fibrillation (AF) were less likely to experience recurrences of arrhythmia at 12 months after undergoing their first catheter ablation for pulmonary vein isolation than older patients (> 45 years).

METHODOLOGY:

• Researchers conducted a retrospective cohort study comparing the efficacy of first-time catheter ablation between young and older adults with AF who underwent the procedure between 2016 and 2023.
• The analysis included 225 patients in the young group (mean age, 39 years; 76% men) who were propensity score matched with 225 patients in the older group (mean age, 58 years; 76% men).
• Ablations were performed using radiofrequency (54%), cryoablation (44%), or pulsed field ablation (2.7%); all antiarrhythmic drugs were discontinued before the procedure, and oral anticoagulants were continued for at least 2 months post-procedure.
• Arrhythmia recurrence, defined as any documented atrial tachyarrhythmia lasting more than 30 seconds, was captured using 24-hour Holter monitoring or additional electrocardiograms.

TAKEAWAY:

• In a 12-month follow-up period, patients in the older group were more likely to experience arrhythmia recurrences than those in the young group (odds ratio [OR], 1.80; P = .01).
• Greater age was associated with increased AF recurrences at 12 months (adjusted OR, 1.02; P = .017).
• The type of ablation was not associated with the likelihood of arrythmia recurrence.
• Youden index analysis found 59 years as the statistically optimal cutoff to predict 12-month AF recurrences after ablation.

IN PRACTICE:

“Recognizing the potential influence of sampling variability and the uncertainty inherent to data‐driven estimations, a more clinically applicable age range of 55 to 60 years may be proposed by our results as an age range above which the risk of AF recurrence following CA [catheter ablation] increases,” the authors wrote.

SOURCE:

This study was led by Ourania Kariki, Onassis Cardiac Surgery Center, Athens, Greece. It was published online on June 03, 2025, in the Journal of Cardiovascular Electrophysiology.

LIMITATIONS:

This study was conducted at a single centre, and data were retrieved retrospectively. Excluding unmatched patients through propensity score matching may have limited the generalisability of the findings. The use of 24-hour Holter monitoring for follow-up may have underestimated the recurrence of arrhythmia.

DISCLOSURES:

This study did not receive any specific funding. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.