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Radiofrequency ablation is moderately effective in the treatment of drug-refractory atrial fibrillation (AF; JW Cardiol Feb 3 2010). However, its effectiveness as a first-line therapy is unclear. In a multicenter, partially industry-supported trial, investigators randomized 294 patients with paroxysmal AF (defined as episodes <7 days in duration) to treatment with ablation or an antiarrhythmic drug (AAD). All patients were aged 70 or younger; other exclusion criteria included prior ablation or AAD use, left atrial diameter >50 mm, and left ventricular ejection fraction <40%.
Ablation operators used standard pulmonary vein isolation techniques guided by three-dimensional mapping systems. AADs were predominantly class IC agents. Patients in th…