Efficacy and safety of atrial fibrillation ablation in patients with Marfan syndrome: A multicenter analysis

Background: Patients with Marfan syndrome (MFS) are at an increased risk of atrial fibrillation (AF) and atrial flutter (AFL), yet data on catheter ablation outcomes in this population remain limited. Objective: This study aimed to evaluate recurrence rates, clinical outcomes, and procedural complications after AF and AFL ablation in patients with MFS. Methods: We conducted a retrospective study of patients with confirmed MFS treated across Mayo Clinic sites from 2018 to 2024. Among 1113 screened patients, 979 had confirmed MFS. After excluding those younger than 18 years and with insufficient follow-up, 209 patients with documented AF or AFL remained, of whom 67 underwent catheter ablation. Collected data included demographics, arrhythmia characteristics, ablation type, recurrence, complications, and echocardiographic findings. Results: Among 67 ablation patients, 41 (61.2%) underwent rhythm-targeted AF ablation, 15 (22.4%) cavotricuspid isthmus ablation, and 11 (16.4%) atrioventricular node ablation. Within the AF ablation group, 26 (63.4%) had paroxysmal AF and 15 (36.6%) persistent AF; 85% also had AFL. Recurrence occurred in 76.9% of patients with paroxysmal AF (median 1.03 years) and in 93.3% of persistent AF (median 0.82 years). Repeat ablation was required in 42.3% and 60%, respectively. Overall, 34 of 41 (82.9%) experienced recurrence, and 20 (48.8%) underwent multiple procedures. Complications occurred in 19 (28.4%), including vascular injury, bleeding, retroperitoneal hemorrhage, pericardial effusion, pulmonary vein stenosis, phrenic nerve injury, and thromboembolic events. Conclusion: In patients with MFS, AF ablation is associated with high recurrence rates, frequent repeat procedures, and notable complication risk. These findings emphasize careful patient selection and vigilant long-term follow-up.