The young patient with asymptomatic atrial fibrillation: what is the evidence to leave the arrhythmia untreated?

Atrial fibrillation (AF) is the most common arrhythmia and has gained increasingly more attention due to new treatment options, particularly catheter ablation. Growing experience with this technique and better AF suppression compared with antiarrhythmic medication have paved the way for its extended use and indication. At this point, it is recommended for symptomatic patients if antiarrhythmic drugs failed and in selected young symptomatic patients as first line therapy. It is a tempting concept to improve prognosis in young AF patients by rhythm control irrespective of symptoms. In this review, we summarize epidemiological data on young AF, efficacy, and limitations of rate and rhythm control by means of medication and catheter ablation in young patients, information on arrhythmia progression and outcome, and the consequences of these data for AF treatment in young, asymptomatic patients.