Atrial fibrillation in adults under 40 years: clinical profile, management strategies, and long-term outcomes after catheter ablation
A Bakytzhanuly, Z H Esylbayev, Y Turubayev, S Yuldashov, Z H Maksut, Y Azatov, O NuralinovAbstract
Background
Atrial fibrillation (AF) in young adults presents a unique clinical challenge, yet comprehensive data on its specific phenotype and long-term outcomes following catheter ablation are scarce. A detailed understanding of this population is essential to refine therapeutic strategies.
Methods
In a multicenter, retrospective cohort study, we analyzed 112 consecutive patients aged <40 years diagnosed with AF. We collected comprehensive baseline characteristics, management strategies, and procedural details. The primary endpoint was freedom from AF recurrence (any episode >30 seconds) after the 3-month blanking period. Multivariable Cox proportional hazards regression was used to identify independent predictors of recurrence.
Results
The cohort (mean age 34 ± 4 years, 72% male) was characterized by a high prevalence of modifiable risk factors, with a mean BMI of 26.1 ± 4.8 kg/m². The majority (81%) had no structural heart disease, and 14% reported a familial AF history. Catheter ablation was the initial rhythm-control strategy in 54% of patients (n=61), utilizing cryoballoon (64%) and radiofrequency (36%) approaches with comparable safety profiles. Over a median follow-up of 28 months (IQR 18–45), single-procedure success was 82%, increasing to 91% after repeat ablation. Persistent AF (HR 3.2, 95% CI 1.2–8.9; p=0.02) and Obesity (BMI >30) (HR 2.5, 95% CI 1.1–5.8; p=0.03) were independent predictors of recurrence. No major procedural complications occurred.
Conclusion
In adults under 40, AF is largely a disorder of otherwise healthy individuals, driven by modifiable factors, and is highly amenable to catheter ablation. Both cryoballoon and radiofrequency ablation are safe and effective, offering durable long-term rhythm control. The identification of persistent AF and obesity as key predictors of recurrence highlights a critical subgroup that would benefit from earlier intervention and aggressive risk-factor modification to optimize outcomes.