Recurrent Atrial Fibrillation After Cryoballoon Ablation in a 23-Year-Old Man

Atrial fibrillation (AF) is exceptionally uncommon before age 30.Exercise-triggered tachyarrhythmias require a structured approach because of the broad differential diagnosis.A 23-year-old man with exertional palpitations, dizziness, and syncope had an exercise-provoked rapid supraventricular tachyarrhythmia with intermittent wide-QRS conduction.An electrophysiological study (EPS) excluded an accessory pathway, identified no other inducible supraventricular or ventricular tachycardia, and documented spontaneous AF.Cryoballoon pulmonary vein isolation was successful and relieved symptoms.Recurrent symptoms and documented relapse atrial tachyarrhythmias two months later led to a redo procedure, which identified reconnection at the posterior left pulmonary vein antra.Radiofrequency re-isolation guided by the CARTO system was performed, with no recurrent symptoms or findings during the six-month follow-up.In young adults with palpitations and tachyarrhythmias, physicians should perform a thorough evaluation, including EPS when appropriate.AF ablation should be first-line treatment in severely symptomatic young patients.