title: Efficacy and risk of atrial fibrillation ablation before 45 years of age.
abstract: BACKGROUND
  Young patients with atrial fibrillation (AF) tend to be more symptomatic and less willing to take long-term medications, yet catheter ablation remains recommended as second-line therapy for AF regardless of age. This study seeks to characterize the effectiveness and risk of AF ablation in the young.
  
  
  RESULTS
  Consecutive (n=1548) patients who underwent 2038 AF ablation procedures were included. Major procedural complications and efficacy were analyzed on the basis of age at the initial procedure: <45 years (group 1), 45 to 54 years (group 2), 55 to 64 years (group 3), and ≥65 years (group 4). AF control was defined as no or rare AF on or off antiarrhythmic drugs. The primary outcome of AF control was similar in all groups; it was achieved in 87% in group 1, 88% in group 2, 88% in group 3, and 82% in group 4 (P=0.06). However, more group 1 patients demonstrated freedom from AF off antiarrhythmic drugs (76%) compared with group 2 at 68%, group 3 at 65%, and group 4 at 53% (P<0.001). There were no major complications in group 1, 10 (1.7%) in group 2, 14 (1.4%) in group 3, and 10 (2.6%) in group 4 (P=0.01).
  
  
  CONCLUSIONS
  In patients younger than 45 years, there is a lower major complication rate and a comparable efficacy rate, with a greater chance of being AF free without antiarrhythmic drugs. These findings suggest that it may be appropriate to consider ablative therapy as first-line therapy in this age group.
authors.affiliation: Department of Medicine, London Health Science Hospital, London, Ontario, Canada. pleongs@uwo.ca
authors.forename: Peter
authors.initials: P
authors.lastname: Leong-Sit
authors.forename: Erica
authors.initials: E
authors.lastname: Zado
authors.forename: David J
authors.initials: DJ
authors.lastname: Callans
authors.forename: Fermin
authors.initials: F
authors.lastname: Garcia
authors.forename: David
authors.initials: D
authors.lastname: Lin
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dixit
authors.forename: Rupa
authors.initials: R
authors.lastname: Bala
authors.forename: Michael P
authors.initials: MP
authors.lastname: Riley
authors.forename: Mathew D
authors.initials: MD
authors.lastname: Hutchinson
authors.forename: Joshua
authors.initials: J
authors.lastname: Cooper
authors.forename: Edward P
authors.initials: EP
authors.lastname: Gerstenfeld
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
mesh_terms: D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000925:Anticoagulants