Young-Onset Atrial Fibrillation: Prevalence and Predictors of Adverse Long-Term Outcomes

Atrial fibrillation (AF) has been traditionally regarded as a disease of aging, although its prevalence in young individuals is now recognized. The long-term prognosis of AF in young individuals, especially in those with preserved ejection fraction, is poorly understood.

The goal of this study was to determine the prevalence and predictors of adverse outcomes in a contemporary cohort of young individuals with AF. A further goal was to determine the etiology of early onset AF.

The YOUNG-AF study is a multicenter retrospective cohort study that included adults diagnosed with a first episode of AF at age ≤45 years with normal left ventricular function and referred for catheter ablation. Major adverse cardiovascular and cerebrovascular events (MACCE) and demographic information were collated. A comparator cohort of 45- to 60-year-old patients, additionally referred for AF ablation, was also collated.

Among 203 patients (mean age 34.8 ± 7.7 years; 79% male), mean ejection fraction was 59% ± 5%. During a median follow-up of 4.9 years (Q1-Q3: 2.5-10.2 years), MACCE occurred in 28% of patients, and new left ventricular dysfunction developed in 13% of cases. Genetic, alcohol, or structural heart disease-associated AF etiology was associated with the highest event burden, whereas idiopathic, non-pulmonary vein triggers, exercise, and vagal-associated AF displayed a more favorable prognosis. Catheter ablation was performed in 180 (88.7%) patients. Recurrence was observed in 70 (39%) patients, with a median time to recurrence of 4.3 months (Q1-Q3: 1.5-10.4 months). The presence of late gadolinium enhancement predicted MACCE and shorter recurrence-free survival (P < 0.01).

Young-onset AF was associated with a significant rate of adverse events, with genetic and structural heart abnormalities conferring the worst prognosis. Young patients continue to do well after catheter ablation, although late gadolinium enhancement may identify a group at particularly high risk.