Catheter ablation of atrial fibrillation in the young: a systematic review and meta-analysis

Aims The differences in the clinical outcomes of rhythm and safety after catheter ablation in young and old atrial fibrillation(AF) patients remain unclear. The purpose of this study was to compare the clinical outcomes of catheter ablation for in young and old AF patients. Methods and results The Medline and EMBASE databases were searched for published articles up to Octomber 2022. Studies that met our predefined inclusion criteria were included. The primary endpoints were freedom from AF/atrial tachycardia (AT) recurrence, safety ouctcomes including the stroke/transient ischaemic attack (TIA), cardiac tamponade and pericardial effusion. After literature search and detailed assessment, 6 studies (9982 patients) were identified. Our analyses showed that the rate of freedom from AF/AT recurrence was higher in young than old AF patients after ablation [odds ratio (OR): 0.58, 95% confidence interval (CI) 0.36–0.92; P -0.02]. Compared to older patients, there were similar rate of adverse outcomes including pericardial effusion /tamponade (OR=0.61, 95%CI 0.29-1.27,P=0.18), hematoma(OR=1.87, 95%CI 0.62,5.63, P=0.27) and stroke/ TIA rate(OR=0.25, 95%CI 0.05,1.41, P=0.12) . Conclusions In younger atrial fibrillation patients, there is a lower major complication rate and a comparable efficacy rate, with a greater chance of being AF free without antiarrhythmic drugs. These findings suggest that it may be appropriate to consider ablative therapy as first-line therapy in this age group.