{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T14:03:38Z","timestamp":1784297018519,"version":"3.55.0"},"reference-count":22,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Atrial fibrillation (AF) is becoming increasingly recognised in younger patients. While both anti\u2010arrhythmic drug therapy and catheter ablation are recognised treatment options, their comparative effects on long\u2010term mortality in younger patients are not known.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To describe an association between all\u2010cause mortality, pharmacotherapy and pulmonary vein isolation in young patients with AF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective observational cohort study using the Alfred Hospital's electronic medical records. Adults aged 18\u201365 at the time of first AF diagnosis were included and stratified into pharmacotherapy\u2010led and catheter ablation\u2010led groups. Inverse probability of treatment weighting was applied across a number of demographic and cardiometabolic covariates, achieving strict balance (standardised mean differences &lt;0.1). All\u2010cause mortality was evaluated using weighted Cox proportional hazards modelling and restricted mean survival time (RMST).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The cohort comprised 1961 patients (1250 pharmacotherapy\u2010led; 711 pulmonary vein isolation (PVI))\u2013led. PVI\u2010led was associated with a significant reduction in all\u2010cause mortality compared with conservative medical therapy (adjusted hazard ratio (HR), 0.24; 95% CI: 0.10\u20130.59;\n                      <jats:italic>P<\/jats:italic>\n                      =\u20090.002) subject to significant residual confounding and selection bias. Over a 10\u2010year RMST, the PVI\u2010led strategy conferred an absolute survival benefit of 0.76\u2009years. Neither strategy significantly reduced the risk of incident heart failure (adjusted HR 1.11; 95% CI: 0.58\u20132.11;\n                      <jats:italic>P<\/jats:italic>\n                      =\u20090.761).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In younger patients and subject to significant residual confounding and selection bias, PVI was associated with significantly lower all\u2010cause mortality than pharmacotherapy. These findings must only be considered hypothesis generating and require prospective validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/imj.70549","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T13:19:33Z","timestamp":1784294373000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of catheter ablation and pharmacotherapy on long\u2010term mortality in young patients with atrial fibrillation"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7872-6977","authenticated-orcid":false,"given":"Nicholas","family":"D'Elia","sequence":"first","affiliation":[{"name":"The Alfred Hospital  Melbourne Australia"},{"name":"Monash University  Melbourne Australia"},{"name":"Cabrini Hospital  Melbourne Australia"},{"name":"The Baker Heart and Diabetes Institute  Melbourne 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University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"William","sequence":"additional","affiliation":[{"name":"The Alfred Hospital  Melbourne Australia"},{"name":"Monash University  Melbourne Australia"},{"name":"The Baker Heart and Diabetes Institute  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rose","family":"Crowley","sequence":"additional","affiliation":[{"name":"The Alfred Hospital  Melbourne Australia"},{"name":"The Baker Heart and Diabetes Institute  Melbourne Australia"},{"name":"Melbourne University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6618-7184","authenticated-orcid":false,"given":"Jonathan","family":"Kalman","sequence":"additional","affiliation":[{"name":"The Baker Heart and Diabetes Institute  Melbourne Australia"},{"name":"The Royal Melbourne Hospital  Melbourne 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