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Background Early and durable rhythm control is of high priority in young adults to mitigate long-term atrial fibrillation (AF) related morbidity. Radiofrequency (RF) and cryoballoon (CB) have both demonstrated efficacy in general AF population, but their comparative long-term performance in young adults remains poorly defined.Objective To document the durability and safety of catheter ablation (CA) for AF in young adults (≤ 45 years).Methods All patients without congenital heart disease who underwent CA at our centre between 2007 and 2020 were included. Patients aged 45 years or younger were analysed for baseline characteristics, ablation strategy, procedural complications, and long-term outcomes.Results Among 7035 consecutive patients undergoing CA for AF, 142 met the inclusion criteria. Median age was 40 (36 – 43) years, 85% were male, left ventricular ejection fraction was 55 ± 8 %, and left atrial diameter was 39 (35 – 43) mm. Obesity (BMI ≥30 kg/m2) was present in 30% of the cohort, and 19% of had received Class I or III antiarrhythmic drugs. Persistent AF (PsAF) was present in 38%. In ≤30 years (n=20) subgroup, 2 (1.40%) had a family history of AF, 1 (0.7%) had structural heart disease, 1 (0.7%) was competitive athlete, and 4 (3%) had co-existing supraventricular tachycardia. Ablation was performed using CB in 66 (46%) and RF catheter ablation in 76 (54%) patients. In the PsAF subgroup, 9% underwent posterior wall, 8% roof line, 6% mitral isthmus, and 19% cavotricuspid isthmus ablation. No major complication was observed. Freedom from arrhythmia following index catheter ablation was 71% in paroxysmal and 61% in persistent AF group (P=0.15). Overall redo ablation rates were 21%.Conclusion Catheter ablation is a safe and effective rhythm control strategy for young adults with AF. Long-term success rates and safety profiles were satisfactory across AF types.Abstract 287 Figure 1Abstract 287 Table 1Baseline and procedure characteristicsPatient characteristicsResult (N= 142)Age in years, median (IQR)40 (36 – 43)Age group (%)18 – 208 (6)26 – 3527 (19)36 – 45107(75)Sex, male (%)121 (85)White race (%)77 (54)BMI (kg/m2)29 ± 7Atrial fibrillation classificationsParoxysmal (%)88 (62)Persistent (%)54 (38)Left ventricular ejection fraction in %, mean (SD)55 ± 8Left atrial diameter in mm, median (IQR)39 (35 - 43)Co-morbiditiesCardiomyopathy (%)7 (5)Hypertension (%)16 (11)Supraventricular tachycardia (%)8 (19)Obesity (%)43 (30)Asthma (%)12 (8)Thyroid disorder (%)3 (2)Class I/III AAD use27 (19)Redo ablation procedure (%)30 (21)