Internal medicine journal · 2026
Effect of catheter ablation and pharmacotherapy on long-term mortality in young patients with atrial fibrillation.
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D'Elia Nicholas, Dragas Mariana, Bevacqua Frank, Prabhu Sandeep, Sugumar Hariharan, Chieng David, Segan Louise, Ling Liang Han, Cho Kenneth, William Jeremy, Crowley Rose, Kalman Jonathan, Kistler Peter, Voskoboinik Aleksandr
Аннотация
BACKGROUND: Atrial fibrillation (AF) is becoming increasingly recognised in younger patients. While both anti-arrhythmic drug therapy and catheter ablation are recognised treatment options, their comparative effects on long-term mortality in younger patients are not known.
AIMS: To describe an association between all-cause mortality, pharmacotherapy and pulmonary vein isolation in young patients with AF.
METHODS: We conducted a retrospective observational cohort study using the Alfred Hospital's electronic medical records. Adults aged 18-65 at the time of first AF diagnosis were included and stratified into pharmacotherapy-led and catheter ablation-led groups. Inverse probability of treatment weighting was applied across a number of demographic and cardiometabolic covariates, achieving strict balance (standardised mean differences <0.1). All-cause mortality was evaluated using weighted Cox proportional hazards modelling and restricted mean survival time (RMST).
RESULTS: The cohort comprised 1961 patients (1250 pharmacotherapy-led; 711 pulmonary vein isolation (PVI))-led. PVI-led was associated with a significant reduction in all-cause mortality compared with conservative medical therapy (adjusted hazard ratio (HR), 0.24; 95% CI: 0.10-0.59; P = 0.002) subject to significant residual confounding and selection bias. Over a 10-year RMST, the PVI-led strategy conferred an absolute survival benefit of 0.76 years. Neither strategy significantly reduced the risk of incident heart failure (adjusted HR 1.11; 95% CI: 0.58-2.11; P = 0.761).
CONCLUSIONS: In younger patients and subject to significant residual confounding and selection bias, PVI was associated with significantly lower all-cause mortality than pharmacotherapy. These findings must only be considered hypothesis generating and require prospective validation.
AIMS: To describe an association between all-cause mortality, pharmacotherapy and pulmonary vein isolation in young patients with AF.
METHODS: We conducted a retrospective observational cohort study using the Alfred Hospital's electronic medical records. Adults aged 18-65 at the time of first AF diagnosis were included and stratified into pharmacotherapy-led and catheter ablation-led groups. Inverse probability of treatment weighting was applied across a number of demographic and cardiometabolic covariates, achieving strict balance (standardised mean differences <0.1). All-cause mortality was evaluated using weighted Cox proportional hazards modelling and restricted mean survival time (RMST).
RESULTS: The cohort comprised 1961 patients (1250 pharmacotherapy-led; 711 pulmonary vein isolation (PVI))-led. PVI-led was associated with a significant reduction in all-cause mortality compared with conservative medical therapy (adjusted hazard ratio (HR), 0.24; 95% CI: 0.10-0.59; P = 0.002) subject to significant residual confounding and selection bias. Over a 10-year RMST, the PVI-led strategy conferred an absolute survival benefit of 0.76 years. Neither strategy significantly reduced the risk of incident heart failure (adjusted HR 1.11; 95% CI: 0.58-2.11; P = 0.761).
CONCLUSIONS: In younger patients and subject to significant residual confounding and selection bias, PVI was associated with significantly lower all-cause mortality than pharmacotherapy. These findings must only be considered hypothesis generating and require prospective validation.