Tijskens Maxime, Bergonti Marco, Spera Francesco, Ascione Ciro, Saenen Johan, Huybrechts Wim, Miljoen Hielko, Riva Stefania, Wittock Anouk, Heidbuchel Hein, Tondo Claudio, Sarkozy Andrea
Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium; University of Antwerp, Antwerp, Belgium.
Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium; Department of Clinical Electrophysiology and Cardiac Pacing, Monzino Cardiac Center, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
Am J Cardiol. 2022 Mar 1;166:45-52. doi: 10.1016/j.amjcard.2021.11.030. Epub 2021 Dec 24.
Etiologic factors and long-term outcomes of catheter ablation of atrial fibrillation (AF) in young patients have not been well characterized. This study aimed to analyze the etiologic factors and outcomes of pulmonary vein isolation (PVI) in patients with young-onset AF (young-AF, defined as having first documented episode <45 years). Consecutive patients with young-AF undergoing PVI (n = 197) in 2 academic centers were enrolled and followed for 36.1 ± 24.5 months. A control group of patients with AF onset ≥45 years (n = 554) was included. The most frequent risk factors in young-AF were intensive exercise (25%), moderate-to-heavy alcohol consumption (23%), and familial AF (22%). Compared with patients with AF onset ≥45-year, patients with young-AF were more often men (82% vs 66%, p <0.001), had more frequently paroxysmal AF (81% vs 60%, p <0.001), had less left atrial dilatation (40.9 ± 6.2 mm vs 44.2 ± 7.2 mm, p <0.001), and had lower 4-year recurrence rate after last PVI procedure (22% vs 45%, p <0.001). In young-AF, structural heart disease (SHD) was the only independent predictor of recurrence. Patients with young-AF selected to undergo cryoballoon (CB) ablation were younger (35.0 ± 7.7 vs 36.6 ± 6.7 years, p = 0.035) and had less persistent AF (6% vs 24%, p = 0.004) and coronary artery disease (2% vs 7%, p = 0.02) compared with radiofrequency ablation. After excluding patients with persistent AF and SHD, there was no difference in single procedural success between radiofrequency or CB PVI (27% vs 17%, p = 0.11). In conclusion, patients with young-AF have diverse etiologies and high single and multiprocedural PVI successes. SHD is the only independent predictor of recurrence. In patients with young-AF, there is a selection bias for CB ablation.
年轻患者心房颤动（AF）导管消融的病因及长期预后尚未得到充分描述。本研究旨在分析年轻发作性房颤（年轻-AF，定义为首次记录发作年龄<45岁）患者肺静脉隔离（PVI）的病因及预后。在2个学术中心连续纳入接受PVI的年轻-AF患者（n = 197），并随访36.1±24.5个月。纳入一组房颤发作年龄≥45岁的对照组患者（n = 554）。年轻-AF最常见的危险因素是高强度运动（25%）、中度至重度饮酒（23%）和家族性房颤（22%）。与房颤发作年龄≥45岁的患者相比，年轻-AF患者男性更多（82%对66%，p<0.001），阵发性房颤更常见（81%对60%，p<0.001），左心房扩张较少（40.9±6.2mm对44.2±7.2mm，p<0.001），最后一次PVI术后4年复发率较低（22%对45%，p<0.001）。在年轻-AF中，结构性心脏病（SHD）是复发的唯一独立预测因素。与射频消融相比，选择接受冷冻球囊（CB）消融的年轻-AF患者更年轻（35.0±7.7岁对36.6±6.7岁，p = 0.035），持续性房颤更少（6%对24%，p = 0.004），冠状动脉疾病更少（2%对7%，p = 0.02）。排除持续性房颤和SHD患者后，射频或CB PVI单次手术成功率无差异（27%对17%，p = 0.11）。总之，年轻-AF患者病因多样，单次和多次PVI成功率高。SHD是复发的唯一独立预测因素。在年轻-AF患者中，CB消融存在选择偏倚。
