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Researchers in Italy conducted a randomized trial to compare circumferential pulmonary-vein ablation with antiarrhythmic drug (AAD) therapy in 198 patients (mean age, 56) with long-standing paroxysmal atrial fibrillation (mean duration, 6 years). All had previously failed AAD therapy with propafenone, dysopiramide, or quinidine as single agents (140 patients) or with digoxin/verapamil combination therapy (58 patients). The AAD therapy in the randomized comparison was flecainide, amiodarone, or sotalol (or flecainide plus one of the other two drugs).
Patients received event monitors to record their rhythms 1 to 3 times daily and when they felt symptoms, for 1 year after randomization. Every 3 months, 48-hour Holter monitoring was obtained at …