Catheter ablation for atrial fibrillation in very young adults — multicentric data from the AF-YOUNG registry

BACKGROUND: Atrial fibrillation below age 30 is rare; ablation outcome data is scarce. OBJECTIVE: The multicenter AF-YOUNG registry analyzed clinical, procedural, and outcome data of consecutive patients ≤30 years undergoing first-time catheter ablation. METHODS: Two high-volume German centers retrospectively included patients ≤30 years undergoing first-time pulmonary vein isolation (PVI) for atrial fibrillation (2005-2025). Recurrence: documented atrial fibrillation after a 90-day blanking period. RESULTS: Of 140 patients (mean age 29.1±3.1 years; 28.6% female), 104 with outcome analysis (paroxysmal 83.6%, persistent atrial fibrillation 16.4%; 18.6% with family history of atrial fibrillation). PVI: Radiofrequency 49.3%, Cryoballoon 45.7%, Pulsed-Field ablation 5%. Mean procedure duration 117 ± 66 min. Over a median follow-up of one year (IQR 0.25-1.74), 10 patients had recurrences. Freedom from atrial fibrillation was 93.6/ 88.2/ 82.1% at 1/ 2/ 3 years; 94.9% at one year after up to two procedures. Paroxysmal vs persistent atrial fibrillation showed better outcome: 98.5% vs. 67.7% at 1 year and 87.8% vs. 50.8% at 3 years (log-rank p<0.001). Three in-hospital complications (2.1%) occurred: one vascular complication requiring surgical repair; a pericarditis and a mild pulmonary-vein stenosis without need for intervention. CONCLUSION: In adults below 30 years, catheter ablation for atrial fibrillation delivers high rhythm control with low complication rates. Benefit is lower in persistent than paroxysmal atrial fibrillation. Atrial fibrillation subtype is the strongest determinant which may argue for early referral to ablation as first-line rhythm control in young adults.