Young-Onset Atrial Fibrillation: Prevalence and Predictors of Adverse Long-Term Outcomes (JCEP October 2026)-Article: Young-Onset Atrial Fibrillation: Prevalence and Predictors of Adverse Long-Term Outcomes

Pdf Summary

The YOUNG-AF study examined long-term outcomes in 203 adults whose first atrial fibrillation (AF) diagnosis occurred by age 45. All had normal left ventricular function initially and had been referred for catheter ablation at three tertiary hospitals in Melbourne. Median follow-up was 4.9 years.<br /><br />Despite preserved baseline function, 28% experienced a major adverse cardiovascular or cerebrovascular event (MACCE); new heart failure or left ventricular dysfunction developed in about 13%. Other recorded outcomes included stroke in 3%, pacemaker implantation in 4%, defibrillator implantation in 8%, and death in 2%. Idiopathic AF was the most common identified cause, followed by genetic, alcohol-related, non-pulmonary-vein trigger, and structural heart disease–associated AF.<br /><br />Outcomes varied by underlying cause. Genetic and structural heart disease–associated AF had the greatest burden of adverse events; alcohol-related AF was also associated with notable risk. Exercise- and vagal-associated AF and AF linked to non-pulmonary-vein triggers generally had more favorable outcomes. Late gadolinium enhancement on cardiac MRI was associated with higher MACCE risk and earlier AF recurrence after ablation.<br /><br />Ablation was performed in 89% of participants. AF recurred in 39% during follow-up, with a median time to recurrence of 4.3 months. Overall recurrence was lower than in the older comparison cohort, although 12-month recurrence rates were similar.<br /><br />The findings suggest that AF in young adults is not necessarily benign, even when heart function is initially normal. The authors recommend long-term follow-up, particularly for patients with signs of myocardial disease or possible genetic causes. Because the study was retrospective and involved patients referred to tertiary ablation centers, selection bias limits how widely its results can be applied; prospective studies are needed.

Meta Tag

Concept Young-onset Atrial Fibrillation

Concept Long-term Adverse Outcome

Concept Late Gadolinium Enhancement

Concept Catheter Ablation

Concept Stroke Risk

Keywords

young atrial fibrillation

long-term outcomes

major adverse cardiovascular events

catheter ablation

left ventricular dysfunction

genetic atrial fibrillation

cardiac MRI

late gadolinium enhancement

stroke risk

AF recurrence

Young-onset Atrial Fibrillation

Long-term Adverse Outcome

Late Gadolinium Enhancement

Catheter Ablation

Stroke Risk