Atrial fibrillation in patients ≤50 years: Clinical characteristics, treatment, risk of ischemic stroke, and outcomes

BACKGROUND Atrial fibrillation (AF) incidence in younger patients has increased in recent years, but there are few data. OBJECTIVE This study aims to evaluate the clinical characteristics and risk factors for ischemic stroke (IS) in hospitalized young AF patients. METHODS We evaluated consecutive AF patients aged 18-50 years hospitalized in a large tertiary medical center (2014-2023). Cox regression was used to analyze risk factors for major adverse cardiac and cerebrovascular events (MACE) and new-onset IS. Propensity score matching was employed to analyze the impact of catheter ablation (CA) on the occurrence of MACE with Kaplan-Meier survival curves. RESULTS The final cohort included 1,358 patients with a median age of 45 (IQR 40.8-48) years, 72.8% were men and 70.4% presented with comorbidities. During 4.5 (IQR 2.7-7.2) years follow-up, 238 patients developed MACE, among which heart failure episodes had the highest incidence. CA can reduce the risk of MACE (hazard ratio [HR]=0.494, P=0.002), and the occurrence of MACE is associated with CHA2DS2-VA scores in young AF patients. Prior IS (HR=10.412, P<0.001) and antiplatelet therapy (HR=3.447, P=0.001) were independent risk factors for new-onset IS, while left ventricular ejection fraction > 0.5 (HR=0.367, P=0.013) was a protective factor. CONCLUSIONS The findings show that AF patients ≤ 50 years old have an unfavorable prognosis, and MACE primarily occurs in those with comorbidities. CA is associated with a reduced risk of MACE. Further prospective controlled studies are needed to provide greater attention and tailored management strategies for this growing population.