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The higher recurrence rate after catheter ablation in younger patients with atrial fibrillation suggesting different pathophysiology

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Abstract

Background

Young atrial fibrillation (AF) patients have been underrepresented in studies of radiofrequency catheter ablation (RFCA) and the outcome of RFCA has not been widely addressed. We investigated age-related differences in clinical features, the recurrence of atrial tachyarrhythmia, and its predictors of patients who underwent RFCA for AF.

Methods

This is a multicenter prospective study of 2799 patients who underwent RFCA for AF in 2017–2020. The patients were divided into two groups — group A (age < 60 years, n = 1269) and group B (age ≥ 60 years, n = 1530) — and a recurrence of any atrial tachyarrhythmia 1 year after RFCA following a 90-day blanking period was compared.

Results

The mean age was 51.6 ± 6.7 and 66.8 ± 5.2 years for groups A and B, respectively. Higher body mass index, smaller left atrium, and more prevalent cardiomyopathy and obstructive sleep apnea were observed in group A. Overall, 1-year atrial tachyarrhythmia-free survival was 85.6% and lower in young patients (83.1% in group A vs. 87.7% in group B, log-rank p < 0.01): adjusted hazard ratio (aHR) of recurrence (95% confidence interval (CI)), 1.45 (1.13–1.86) for group A compared to group B (p < 0.01). The association between younger age and higher recurrence was continuously observed in patients under 60 years. Any non-PV ablation was associated with a lower recurrence of atrial tachyarrhythmia in group B (aHR 0.68 (0.47–0.96), p < 0.05), but not in group A.

Conclusions

AF patients younger than 60 years had a higher 1-year AF recurrence after RFCA. Young AF patients might have distinctive pathophysiology of AF requiring more integrated management.

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Data Availability

All data generated or analyzed during this study are included in this published article and its supplementary information files.

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Acknowledgements

We would like to thank all KARA investigators: Jinhee Ahn, Min‑Soo Ahn, Yong‑Soo Baek, Myung‑Jin Cha, Tae‑Joon Cha, Eue‑Keun Choi, Hyung‑Oh Choi, Jong‑Il Choi, Kwang Jin Chun, Hye Bin Gwag, Seongwook Han, Youmi Hwang, Dae Woo Hyun, Eun‑Sun Jin, Ki‑Woon Kang, Dae‑Hyeok Kim, Dae‑Kyung Kim, Dongmin Kim, Ji‑Hoon Kim, Jin‑Bae Kim, Minsu Kim, Sung‑Hwan Kim, Yoo Ri Kim, Young‑Hoon Kim, Jum‑Suk Ko, Jae‑Jin Kwak, Euijae Lee, Sanghee Lee, So‑Ryoung Lee, Sung Ho Lee, Young Soo Lee, Gi‑Byung Nam, Jun Namgung, Il‑Young Oh, Seil Oh, Yong‑Seog Oh, Young Keun On, Hui‑Nam Pak, Hwan‑Cheol Park, Hyoung‑Seob Park, Hyung Wook Park, Sang Weon Park, Ye Min Park, Young‑Ah Park, Kyoung‑Suk Rhee, Jaemin Shim, Dong‑Gu Shin, In‑Geol Song, Jung‑Hoon Sung, and Pil‑Sung Yang.

Funding

This nationwide registry study was supported by a grant from the Korean Heart Rhythm Society 2017.

Author information

Author notes

  1. Hyo-Jeong Ahn, Myung-Jin Cha, and Euijae Lee contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea

    Hyo- Jeong Ahn, So-Ryoung Lee & Eue-Keun Choi

  2. Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Myung-Jin Cha & Gi-Byung Nam

  3. Department of Cardiology, Bucheon Sejong Hospital, Bucheon, Republic of Korea

    Euijae Lee & Sang Weon Park

  4. Department of Internal Medicine, Keimyung University Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Republic of Korea

    Seongwook Han

  5. Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea

    Jong-Il Choi & Young-Hoon Kim

  6. Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Hui-Nam Pak

  7. Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

    Il-Young Oh

  8. Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Republic of Korea

    Dong-Gu Shin

  9. Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Young Keun On

  10. Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea

    Seil Oh

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  1. Hyo- Jeong Ahn
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Correspondence to Seil Oh.

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Ahn, H.J., Cha, MJ., Lee, E. et al. The higher recurrence rate after catheter ablation in younger patients with atrial fibrillation suggesting different pathophysiology. J Interv Card Electrophysiol 66, 1609–1619 (2023). https://doi.org/10.1007/s10840-022-01461-0

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