Age-related differences in clinical, echocardiographic, and outcome profiles in patients undergoing atrial fibrillation ablation

Abstract Background Atrial fibrillation (AF) varies with age in terms of clinical features, structural remodelling, and treatment response. Although pulmonary vein isolation (PVI) is a key rhythm control strategy, the impact of age-related atrial changes on long-term outcomes is unclear. Purpose To compare clinical profiles, echocardiographic parameters, and long-term arrhythmia recurrence between patients aged ≤60 and >60 years undergoing first-time PVI. Methods In this retrospective, single-center study, AF patients with prior formal echocardiographic evaluation undergoing first-time PVI between 2015–2024 were stratified by age. Clinical and pre-procedural echocardiographic data, including left atrial strain (LAS) measures, were compared. AF recurrence was assessed using available 12-lead ECGs or rhythm Holter monitoring. Kaplan–Meier analysis and the log-rank test were used to determine recurrence risk. Results Of 216 patients who underwent PVI, 72 met inclusion criteria, (≤60 years: n=31; >60 years: n=41). Younger patients were more often male (74.2% vs. 51.2%, p=0.04) with less hypertension (38.7% vs. 63.4%, p=0.04). Antiarrhythmic use (54.8% vs. 48.8%, p=0.61) and symptom burden (77.4% vs. 65.9%, p=0.29) were similar. Time from echocardiography to PVI was 312 days [IQR 120–610], and the interval from AF diagnosis to ablation did not differ significantly (854 vs. 1143 days, p=0.61). Older patients showed more atrial remodelling, with larger indexed left atrial diameter (22.0±3.0 vs. 20.1±2.5mm/m², p