Background. Atrial fibrillation (AF) has been traditionally regarded as a disease of ageing, although its prevalence in young individuals is now recognised. The long-term prognosis of AF in young individuals, especially in those with preserved ejection fraction (EF), is poorly understood.
Objectives. To determine the prevalence and predictors of adverse outcomes in a contemporary cohort of young individuals with AF. Furthermore, to determine the aetiology of early onset AF.
Methods. The YOUNG-AF study is a multicentre retrospective cohort study that included adults diagnosed with a first episode of AF at ≤45 years with normal LV function and referred for catheter ablation. Major adverse cardiovascular and cerebrovascular events (MACCE) and demographic information were collated. A comparator cohort of 45-60-year-olds, also referred for AF ablation, was also collated.
Results. Among 203 patients (mean age 34.8 ± 7.7, 79% male), the mean EF was 59 ± 5%. During a median follow-up of 4.9 [2.5,10.2] years, MACCE occurred in 28% of patients, and new LV dysfunction developed in 13% of cases. Genetic, alcohol or structural heart disease-associated AF aetiology were associated with the highest event burden, whilst idiopathic, non-pulmonary vein triggers, exercise and vagal-associated AF demonstrated a more favourable prognosis. Catheter ablation was performed in 180 (88.7%) of patients. Recurrence was observed in 70 (39%) patients, with a median time to recurrence of 4.3 [1.5-10.4] months. The presence of late gadolinium enhancement (LGE) predicted MACCE and shorter recurrence-free survival (p<0.01).
Conclusion. Young-onset AF was associated with a significant rate of adverse events, with genetic and structural heart abnormalities conferring the worst prognosis. Young patients continue to do well after catheter ablation, although LGE may identify a group at particularly high risk.
Editor-in-Chief
Kalyanam Shivkumar, MD, PhD, FACC
CME Editor
Kenneth A. Ellenbogen, MD, FACC
Authors
Nicholas D'Elia, BNScu, MBBS, BDIP
Mariana Dragas, MD
Aleksandr Voskoboinik, MBBS, PhD
Important Dates
Date of Release: October 26, 2026
Term of Approval/Date of CME/MOC Expiration: October 25, 2027