Younger patients (≤60 years) had significantly less atrial fibrillation recurrence at 1 year after first-time pulmonary vein isolation compared to older patients (HR 0.27; 95% CI 0.10-0.74; p=0.01).
Cohort (n=72)
No
Does age ≤60 years compared to >60 years reduce atrial fibrillation recurrence in patients undergoing first-time pulmonary vein isolation?
Hazard Ratio: 0.27 (95% CI 0.1–0.74)
p-value: p=0.01
Abstract Background Atrial fibrillation (AF) varies with age in terms of clinical features, structural remodelling, and treatment response. Although pulmonary vein isolation (PVI) is a key rhythm control strategy, the impact of age-related atrial changes on long-term outcomes is unclear. Purpose To compare clinical profiles, echocardiographic parameters, and long-term arrhythmia recurrence between patients aged ≤60 and 60 years undergoing first-time PVI. Methods In this retrospective, single-center study, AF patients with prior formal echocardiographic evaluation undergoing first-time PVI between 2015–2024 were stratified by age. Clinical and pre-procedural echocardiographic data, including left atrial strain (LAS) measures, were compared. AF recurrence was assessed using available 12-lead ECGs or rhythm Holter monitoring. Kaplan–Meier analysis and the log-rank test were used to determine recurrence risk. Results Of 216 patients who underwent PVI, 72 met inclusion criteria, (≤60 years: n=31; 60 years: n=41). Younger patients were more often male (74.2% vs. 51.2%, p=0.04) with less hypertension (38.7% vs. 63.4%, p=0.04). Antiarrhythmic use (54.8% vs. 48.8%, p=0.61) and symptom burden (77.4% vs. 65.9%, p=0.29) were similar. Time from echocardiography to PVI was 312 days IQR 120–610, and the interval from AF diagnosis to ablation did not differ significantly (854 vs. 1143 days, p=0.61). Older patients showed more atrial remodelling, with larger indexed left atrial diameter (22.0±3.0 vs. 20.1±2.5mm/m², p0.01) and volume (36.3±8.7 vs. 30.1±9.7mL/m², p0.01). Younger patients had more impaired left ventricular global longitudinal strain (–17.6% –18.8 to –16.3 vs. –19.4% –20.5 to –18.2, p=0.03) and a trend towards lower LVEF (57.0±10.1% vs. 61.6±9.0%, p=0.06). Lateral e′ was lower in older patients (10.3±2.8 vs. 12.3±3.1 cm/s, p=0.01); septal e′ and E/e′ were similar. LAS of reservoir was slightly reduced in older patients (23.2±6.4% vs. 27.4±9.5%, p=0.06), with significantly lower LAS of conduit (10.6±3.8% vs. 15.1±7.2%, p=0.01). LAS of contraction was similar. At a mean follow-up of 652.6±576.6 days, younger patients had significantly less AF recurrence at 1 year (HR 0.27; 95% CI: 0.10–0.74; p=0.01), with a non-significant trend persisting at 3 years (HR 0.39; 95% CI: 0.15–1.02; p=0.05). Conclusions In this retrospective study of first-time PVI patients, younger individuals (≤60 years) had less atrial remodelling and better short-term rhythm outcomes, underscoring the influence of age-related structural differences and the potential value of advanced parameters like left atrial strain in patient selection. However, the study is limited by a small sample size, high dropout rate, selection bias, and a single-center design. Variability in timing between AF diagnosis, imaging, and ablation may have introduced heterogeneity, and intermittent monitoring likely underestimated asymptomatic recurrences. The retrospective design also limits causal inferences.
Garcia et al. (Thu,) conducted a cohort in Atrial fibrillation (n=72). Age ≤60 years vs. Age >60 years was evaluated on Atrial fibrillation recurrence at 1 year (HR 0.27, 95% CI 0.10-0.74, p=0.01). Younger patients (≤60 years) had significantly less atrial fibrillation recurrence at 1 year after first-time pulmonary vein isolation compared to older patients (HR 0.27; 95% CI 0.10-0.74; p=0.01).