Nov. 01, 2023
Atrial fibrillation (AFib) affects millions of patients worldwide, and it is the most common arrhythmia. It is infrequent in the younger population, and management and outcomes are based on studies with older patients.
But AFib can occur in young patients without congenital or other structural heart diseases that are often found in older patients. It still brings the risk of poor quality of life, increased rate of hospitalizations, congestive heart failure and ischemic stroke. With advanced monitoring and technology, such as smart devices with electrocardiograms, there will likely be more AFib cases detected in younger populations.
Catheter ablation for AFib in young patients has previously been safe with low complication rates. Studies have suggested that catheter ablation may be a favorable therapeutic option for young patients with AFib. But the efficacy of catheter ablation for young patients with AFib is scarce, says Andrew S. Tseng, M.D., a cardiologist at Mayo Clinic in Jacksonville, Florida, and first author of the study published in the February 2023 issue of BMC Cardiovascular Disorders.
This study looked at one-year outcomes of ablation in patients with AFib using the Nationwide Readmissions Database (NRD), a subset of the Healthcare Cost and Utilization Project (HCUP) from the Agency for Healthcare Research and Quality (AHRQ), from 2016 to 2017. The data includes 17 million discharges from 26 states. Patients between ages 18 and 50 with AFib were identified.
A total of 52,598 patients, with median age of 44 and 25.7% female, were included in the study, and 2,146 of those patients underwent catheter ablation. The risk of readmission for AFib a year post-ablation was lower (5.2%) than for patients without ablation (9.0%). For any cause, one-year readmission rates were 17.2% for patients with ablation and 21.3% for patients without ablation.
- Young patients with AFib who underwent catheter ablation had lower readmission rates for AFib, stroke or any cause.
- No difference in mortality at one year.
- Significant demographic, socioeconomic and comorbidity differences in patients who had ablations compared with those who did not.
The study also showed that overall physical health, comorbidities and social determinants were all factors that could lead to selection bias in patients with AFib who were offered ablation. More affluent patients were referred for ablation. Nonwhite patients and patients with low incomes had lower rates of ablation.
Patients were likely to have the ablation in large teaching hospitals where higher volumes of ablations are performed, which could have contributed to the positive outcomes. Further research is needed to show a long-term analysis and to include young patients with AFib from a diverse population.
For more information
Tseng AS, et al. One-year outcomes of catheter ablation for atrial fibrillation in young patients. BMC Cardiovascular Disorders. 2023;23:83.
Refer a patient to Mayo Clinic.