Problem Paroxysmal AF
Format Single-center RCT
Treatment AF ablation (CPVA)
Control Maximum tolerable ADT
Population 198 patients
Inclusion criteria One hundred ninety-eight patients (age, 56  10 years) with PAF of 6  5 years’ duration
(mean AF episodes 3.4/month) who had failed ADT

Age 18 or 70 yrs
Creatinine concentration 1.5 mg/dl
AF history 6 months
AF burden 2 episodes/month in the last 6 months*

*The AF burden was quantiï¬Åed before enrolment by review of patient charts.
Exclusion criteria AF secondary to transient or correctable abnormality
Intra-atrial thrombus, tumor precluding catheter insertion
LA diameter 65 mm
Left ventricular ejection fraction 35%
HF symptoms  NYHA functional class II
Prior ADT therapy with amiodarone, flecainide, and sotalol
Contraindication to beta-blocking therapy
Patients with rheumatic mitral valve disease
Unstable angina or acute or prior myocardial infarction (6 months)
Wolff-Parkinson-White syndrome
Renal or hepatic failure
Implanted device (pacemaker or cardioverter-deï¬Åbrillator)
Need for antiarrhythmic therapy for arrhythmias other than AF
Contraindication to ADT† or anticoagulation with warfarin
History of a cerebrovascular accident
Prior attempt at catheter or surgical ablation for AF

†Thyroid dysfunction, interstitial lung disease with DLCO 70% of predicted or
severe asthma, QT interval exceeding 400 ms, symptomatic sinus node or atrioventricular node dysfunction unless a pacemaker is implanted, or evidence of stressinduced myocardial ischemia.
ADT  antiarrhythmic drug therapy; AF  atrial ï¬Åbrillation; DLCO  diffusion
capacity of the lung for carbon monoxide; HF  heart failure; LA  left atrial;
NYHA  New York Heart Association.
Follow-up 12 months
Primary endpoint Freedom from documented recurrent AT during a 12-month follow-up in patients who underwent CPVA and in those receiving ADT. The end point was reached with the ï¬Årst episode of AT, and cases with a second ADT or repeat ablation procedure were considered failures. Recurrence of AT was deï¬Åned as AT that lasted at least 30 s
Secondary endpoint(s) Nil
Details -
Brief summary: PAF patients who failed ADT did well with RF ablation at 1 year
PAPER: A randomized trial of circumferential pulmonary vein ablation versus antiarrhythmic drug therapy in paroxysmal atrial fibrillation: the APAF Study.
Date 5 Dec 2006
Journal J Am Coll Cardiol. 2006 Dec 5;48(11):2340-7.
Information Those not having had recurrent atrial tachycardia
-86% assigned to ablation free of atrial tachycardias
-vs. 22% assigned to medical Rx (P<0.001)
Hospitalisations for CV disease less frequent in ablation group.