Abstract

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

Keywords: Atrial fibrillation; Catheter ablation; Complications; Young patients