Pulmonary vein isolation in early-onset atrial fibrillation (age ≤ 50 years): A multicenter comparison of pulsed-field ablation vs thermal energy sources.

BACKGROUND

Pulsed-field ablation (PFA) has emerged as a promising energy source for pulmonary vein isolation (PVI) because of its tissue selectivity and procedural efficiency. However, its role in younger patients with atrial fibrillation (AF) remains underexplored.

OBJECTIVE

This study compared the procedural characteristics, safety, and effectiveness of PFA, cryoballoon ablation (Cryo), and radiofrequency ablation (RFA) in patients 50 years or younger with early-onset AF.

METHODS

Consecutive patients 50 years or younger undergoing first PVI with PFA, Cryo, or RFA at 2 tertiary centers were enrolled and followed for 1 year.

RESULTS

Of 368 patients (median age 46 years; 64 (17%) female; 233 (63%) with paroxysmal AF), 119 (32%) underwent PFA, 95 (26%) Cryo, and 154 (42%) RFA. Median procedure durations were shorter for PFA (59 minutes) and Cryo (63 minutes) vs RFA (94 minutes) (P < .001). Left atrial dwell times were also shorter with PFA (36 minutes) and Cryo (44 minutes) vs RFA (76 minutes) (P < .001). Successful acute PVI was achieved in all patients. Overall, there were 3 major complications (0.8%): 1 phrenic nerve palsy (1.1%) in the Cryo group and 2 cases of tamponade (1.3%) in the RFA group. 1-year Kaplan-Meier recurrence-free survival was 69% in PFA, 61% in Cryo, and 73% in RFA (PLog-rank = .064).

CONCLUSION

In this multicenter study of young patients undergoing first-time PVI, PFA demonstrated favorable procedural efficiency, safety, and effectiveness, supporting its potential as an effective modality in patients with early-onset AF. These findings warrant further investigation in larger data sets.