First-Line Therapy for AFib: Catheter Ablation vs. Antiarrhythmic Drugs

Catheter ablation, an effective treatment for highly symptomatic atrial fibrillation (AF), has generally been restricted to AF that is refractory to treatment with one or more antiarrhythmic drugs (AADs), because of the procedure's small but real potential for serious complications, including stroke, pulmonary-vein stenosis, tamponade, and esophageal perforation.

Now, in a randomized trial conducted at three centers in Italy and Germany, researchers have compared catheter-based pulmonary-vein isolation (PVI) with physician-guided AAD therapy in 70 adults (mean age, 54) with symptomatic monthly episodes of AF for at least 3 months; none had previously received AADs or undergone catheter ablation. Almost all patients (96%) had paroxysmal AF. T…