16-07: Long-Term Results of Catheter Ablation for Persistent Atrial Fibrillation in Very Young Adults – Lessons from a 4-year follow up

Introduction: Catheter ablation is an established treatment option for symptomatic atrial fibrillation (AF). Current guidelines recommend catheter ablation for drug-refractory short-standing persistent AF. However, long-term data on the efficacy and safety of catheter ablation for persistent AF in young adults is very limited.

Methods: Ablation strategy during index procedure was circumferential pulmonary vein isolation (PVI). Additional ablation of complex fractionated atrial electrograms (CFAE) or linear lesions was only performed if AF persisted and direct current cardioversion failed after PVI. Acute procedural end points were stable sinus rhythm and complete PVI (entrance block) verified by circular mapping catheter recordings within the PVs, and complete conduction block across atrial lines. Follow-up was based on regular outpatient clinic visits including 24h Holter-ECGs and telephonic interviews. Recurrence was defined as any symptomatic and/or documented atrial tachyarrhythmia episode >30 s after a 3-months blanking period.

Results: From 2005 to 2014, 33 consecutive young adults (6 women, 30 ± 4 years) with symptomatic persistent AF underwent catheter ablation. Structural/congenital heart disease was present in 6/33 (18%) patients. Acute procedural success was achieved in all patients applying either radiofrequency current guided by 3D mapping (n = 29) or using the cryoballoon (n = 4). Linear lesions and CFAE ablation was performed in 4/33 (12%) and 2/33 (6%) patients, respectively. Five patients were lost to follow-up. During a mean follow-up of 49 ± 25 months stable sinus rhythm was achieved in 43% after a single procedure, and in 82% after a mean of 2.0 procedures. A second procedure was performed in 13, and a third procedure in 2 patients. PV reconduction was observed in 12 patients (92%) during the second, and in 1 patient (50%) during the third procedure. EHRA score significantly improved until last follow-up (mean 3.2 to 1.4, p < 0.01). Major periprocedural complications occurred in 3 patients (1 major stroke, 1 pulmonary vein stenosis, 1 AV fistula requiring surgery).

Conclusions: In the majority of very young adults ≤35 years of age, catheter ablation for persistent AF is effective during long-term follow-up and associated with an acceptable complication rate.