Abstract
Introduction: Catheter ablation is an established therapy for the treatment of symptomatic atrial fibrillation (AF). Current guidelines recommend catheter ablation for drug-refractory paroxysmal AF (PAF) in adults, and as first-line therapy in selected patients. However, long-term data on the efficacy and safety of catheter ablation for PAF in young adults is very limited. Methods: From 2005 to 2014, 52 consecutive young adults (32 men, 20 women) with symptomatic PAF underwent pulmonary vein isolation (PVI). The procedure end point was complete PVI (entrance block) verified by circular catheters placed within the PVs. Follow-up was based on regular outpatient clinic visits including 24h Holter-ECGs and telephone interviews at last follow-up. Recurrence was defined as any symptomatic and/or documented atrial tachyarrhythmia episode [30 s following a 3-month blanking period]. Results: Mean patient age at the time of the index procedure was 30 ± 4 years (range 19-35). Complete PVI by either radiofrequency current guided by 3-dimensional mapping (n = 50) or cryoballoon (n = 2) was achieved in 51/52 patients (98%). Six patients were lost to follow-up. During a mean follow-up period of 4.9 years (range 1.0-9.7 years) stable sinus rhythm was achieved in 65% after a single procedure, and in 83% after multiple procedures (mean 1.5; range 1-3). Success rate at last follow-up off anti-arrhythmic drugs was 74%. Eight patients (17%; 3 with stable sinus rhythm) were taking antiarrhythmic drugs (AAD; only class I) at last follow-up compared to 26 patients (57%, p < 0.01) before the index procedure. A second procedure was performed in 19, and a third procedure in 2 patients. PV reconduction was observed in 16 patients (84%) during the second, and in 1 patient (50%) during the third procedure. EHRA score significantly improved at last follow-up (mean 3.2 to 1.2, p < 0.001). Major periprocedural complications occurred in 3 patients (tamponade in 1, PV stenosis in 2). No patient progressed towards persistent AF. Conclusions: In the majority of very young adults ≤35 years of age, catheter ablation for PAF is effective during long-term follow-up and associated with a low complication rate. These findings support the concept of PVI in very young adults with symptomatic PAF.
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