Atrial fibrillation in patients less than 50 years clinical characteristics, treatment, risk of ischemic stroke, and outcomes

Abstract Background Atrial fibrillation (AF) incidence in younger patients has increased in recent years, but there are few data. This study aims to evaluate the clinical characteristics and risk factors for ischemic stroke (IS) in 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 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. Catheter ablation can reduce the risk of MACE (HR=0. 225, P0. 001), and the occurrence of MACE is associated with CHA2DS2-VA scores in young AF patients (Figure 1). Previous IS (HR=10. 412, P0. 001) and antiplatelet therapy (HR=3. 447, P=0. 001) were independent risk factors for new-onset IS, while left ventricular ejection fraction50% (HR=0. 367, P=0. 013) was a protective factor. Conclusions The findings show that young AF patients ≤50 years have an unfavorable prognosis, and MACE primarily occurs in those with comorbidities. Catheter ablation is associated with a reduced risk of MACE (Figure 2). Further prospective controlled studies are needed to provide greater attention and tailored management strategies for this growing population. K-M survival curves of MACEgraphicalₐbstract