JACC Clin Electrophysiol. 2026 May 15:S2405-500X(26)00425-1. doi: 10.1016/j.jacep.2026.04.018. Online ahead of print.
ABSTRACT
BACKGROUND: 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.
OBJECTIVES: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
PMID:42283657 | DOI:10.1016/j.jacep.2026.04.018