Catheter ablation for atrial fibrillation in very young adults – multicentric data from an observational registry

Background and Objective: Data on effectivity and saftety of catheter ablation of atrial fibrillation in adults younger than 30 years is scarce. We aimed at investigating the clinical characteristics, procedural details, and outcome of catheter ablation in this population.

Methods: We performed a retrospective, observational multicentre analysis of consecutive patients ≤ 30 years undergoing pulmonary‑vein isolation (PVI) for management of AF.

Results: Between 2005 and 2025, 140 patients (71 % male; mean age 29.1 ± 6.4 years) below  30 years underwent first‑time PVI (49.3 % radiofrequency, 45.7 % cryoballoon, and 5 % pulsed‑field) with a mean procedure duration of 116.6 ± 66.3 min and median hospital stay of 2 days (IQR 2–3). Arterial hypertension was present in 15.7 %, diabetes in 1.4 %, and the median CHA₂DS₂‑VA score was 0 (IQR 0–1). Paroxysmal AF accounted for 83.6 % of cases and persistent AF for 16.4 %; intraprocedural cardioversion was required in 22.9 %. Major complications occurred in 1.4 % (n=2, one femoral vascular repair, one pulmonary‑vein stenosis). Over a median follow‑up of 1.0 year (IQR 0.25–1.74), 83 % of patients remained arrhythmia‑free after a single procedure; an additional 7 % achieved freedom from atrial tachyarrhythmia following a second ablation, yielding a cumulative success rate of 90 %. Antiarrhythmic drugs were prescribed at discharge in 28 % (22 % amiodarone). Women had a lower BMI (23.8 vs. 25.3 kg/m²; p = 0.014) and higher prior‑stroke prevalence (7.5 % vs. 0; p = 0.022), but acute efficacy and safety were similar across sexes.

Conclusion: In adults ≤ 30, catheter ablation of AF is associated with low complication rates and high arrhythmia‑free survival, supporting its role for rhythm control in young adults.