Pulmonary Vein Isolation in Early-Onset Atrial Fibrillation (≤50 Years): A Multicenter Comparison of Pulsed-Field Ablation versus Thermal Energy Sources.

Background Pulsed-field ablation (PFA) has emerged as a promising energy source for pulmonary vein isolation (PVI) due to its tissue selectivity and procedural efficiency. However, its role in younger patients with atrial fibrillation (AF) remains underexplored.Objective This study compared procedural characteristics, safety, and effectiveness of PFA, cryoballoon ablation (Cryo), and radiofrequency ablation (RFA) in patients aged ≤50 years with early-onset AF.Methods Consecutive patients ≤50 years undergoing a first PVI with PFA, Cryo, or RFA at two tertiary centers were enrolled and followed for one year.Results Among 368 patients (median age 46 years, 17% female, 63% with paroxysmal AF), 119 (32%) underwent PFA, 95 (26%) Cryo, and 154 (42%) RFA. Median procedure durations were shorter for PFA (59 min) and Cryo (63 min) vs. RFA (94 min; p <0.001). Left atrial dwell times were also shorter with PFA (36 min) and Cryo (44 min) vs. RFA (76 min; p <0.001). Successful acute PVI was achieved in all patients. Overall, there were 3 major complications (0.8%): 1 phrenic nerve palsy (1.1%) in the Cryo group and 2 cases of tamponade (1.3%) in the RFA group. 1-year Kaplan-Meier recurrence-free survival was 69% in PFA, 61% in Cryo, and 73% in RFA (pLog-rank = 0.064).Conclusion In this multicenter study of young patients undergoing first-time PVI, PFA demonstrated favorable procedural efficiency, safety, and effectiveness supporting its potential as an effective modality in patients with early-onset AF. These findings warrant further investigation in larger data sets.