Recurrent Atrial Fibrillation After Cryoballoon Ablation in a 23-Year-Old Man

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Exercise-triggered paroxysmal atrial fibrillation with rapid ventricular response (n=1). Intervention: Cryoballoon pulmonary vein isolation followed by CARTO-guided radiofrequency redo ablation. Primary outcome: Freedom from recurrent atrial tachyarrhythmia and symptoms after redo radiofrequency ablation.

Nikolaos Panagiotis Margos; Panagiotis Margos; Ilias G. Patsiotis; Konstantinos Trachanas; Konstantinos G. Kostopoulos

doi:10.7759/cureus.118651

October 26, 2026CureusOpen Access

Recurrent Atrial Fibrillation After Cryoballoon Ablation in a 23-Year-Old Man

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Key result

Targeted radiofrequency re-isolation eliminates recurrent AF at 6 months following failed cryoballoon ablation.

n=1

Why the study?

Atrial fibrillation is exceptionally uncommon before age 30, and exercise-triggered tachyarrhythmias require a structured evaluation because of their broad differential diagnosis.

Key Points

To describe the diagnostic evaluation and catheter ablation management of exercise-provoked recurrent atrial fibrillation in a young adult.
Evaluated a 23-year-old man presenting with exertional palpitations, dizziness, syncope, and exercise-provoked rapid supraventricular tachyarrhythmia with intermittent wide-QRS conduction.
Performed an electrophysiological study to exclude accessory pathways and other inducible tachycardias, followed by cryoballoon pulmonary vein isolation.
Conducted a redo electrophysiological procedure with three-dimensional electroanatomic mapping and radiofrequency re-isolation following symptom relapse at two months.
Electrophysiological study excluded an accessory pathway and inducible ventricular or supraventricular tachycardias, confirming spontaneous atrial fibrillation that was initially relieved by cryoballoon ablation.
Repeat mapping two months later revealed recovered electrical conduction at the posterior aspect of the left pulmonary vein antra, which was successfully eliminated with radiofrequency ablation.
The patient experienced no recurrent symptoms or arrhythmic findings during the six-month follow-up period.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 young adult man (age 23) with severe exercise-provoked paroxysmal atrial fibrillation, syncope, and structurally normal heart, followed for 6 months after redo ablation.

I

Intervention

Initial pulmonary vein isolation (PVI) using a 28-mm fourth-generation Arctic Front Advance Pro cryoballoon (single 240-second application per vein) with IV unfractionated heparin (100 IU/kg); followed two months later by a redo procedure using CARTO 3D electroanatomic mapping and targeted point-by-point radiofrequency (RF) ablation to re-isolate the posterior aspect of the left pulmonary vein antra.

O

Outcome

Freedom from recurrent symptoms (exertional palpitations, syncope) and atrial tachyarrhythmias on repeat ambulatory Holter monitoring over a 6-month follow-up period after redo ablation.patient reported

This case illustrates that severely symptomatic, exercise-triggered atrial fibrillation in a young adult can be effectively managed with initial cryoballoon pulmonary vein isolation and, upon recurrence due to pulmonary vein reconnection, targeted 3D electroanatomic mapping-guided radiofrequency re-isolation.

Limitations

Single-patient case report limiting generalizability
Genetic testing and pharmacological provocation testing with ajmaline were deferred
Syncopal events were not captured on ECG, making their causal relationship with atrial fibrillation inferential
Syncopal events were not captured on ECG, so their causal relationship with AF remains inferential
Genetic testing and pharmacological provocation testing with ajmaline were deferred, which does not exclude functional atrial disease or an occult inherited disorder

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Implication

May support redo RF re-isolation for early post-cryoballoon recurrence; leaves open durability and optimal strategy in prospective trials.

Abstract

Atrial fibrillation (AF) is exceptionally uncommon before age 30.Exercise-triggered tachyarrhythmias require a structured approach because of the broad differential diagnosis.A 23-year-old man with exertional palpitations, dizziness, and syncope had an exercise-provoked rapid supraventricular tachyarrhythmia with intermittent wide-QRS conduction.An electrophysiological study (EPS) excluded an accessory pathway, identified no other inducible supraventricular or ventricular tachycardia, and documented spontaneous AF.Cryoballoon pulmonary vein isolation was successful and relieved symptoms.Recurrent symptoms and documented relapse atrial tachyarrhythmias two months later led to a redo procedure, which identified reconnection at the posterior left pulmonary vein antra.Radiofrequency re-isolation guided by the CARTO system was performed, with no recurrent symptoms or findings during the six-month follow-up.In young adults with palpitations and tachyarrhythmias, physicians should perform a thorough evaluation, including EPS when appropriate.AF ablation should be first-line treatment in severely symptomatic young patients.

Discussion

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Cite This Study

Margos et al. (2026) conducted a case report in Exercise-triggered paroxysmal atrial fibrillation with rapid ventricular response (n=1). Cryoballoon pulmonary vein isolation followed by CARTO-guided radiofrequency redo ablation was evaluated on Freedom from recurrent atrial tachyarrhythmia and symptoms after redo radiofrequency ablation. Targeted radiofrequency re-isolation of reconnected posterior left pulmonary veins eliminated AF recurrence over 6 months after relapse at 2 months post-cryoballoon ablation in a 23-year-old man.

synapsesocial.com/papers/6ae2e24e61f440a81e65843b https://doi.org/10.7759/cureus.118651

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Recurrent Atrial Fibrillation After Cryoballoon Ablation in a 23-Year-Old Man

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Recurrent Atrial Fibrillation After Cryoballoon Ablation in a 23-Year-Old Man

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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