Problem Paroxysmal AF (first line)
Format Multicenter, randomised trial
Treatment Radiofrequency catheter ablation
Control Class IC or class III antiarrhythmic agents
Population 294 patients
Inclusion criteria At least two episodes of symptomatic atrial fibrillation within the preceding 6 months but no episode of atrial fibrillation that was longer than 7 days (without spontaneous termination or cardioversion)
Exclusion criteria Age of more than 70 years
Previous or ongoing treatment with class IC or class III antiarrhythmic drugs
Contraindication to both class IC and class III agents
Previous ablation for atrial fibrillation
Left atrial diameter of more than 50 mm
Left ventricular ejection fraction of less than 40%
Contraindication to oral anticoagulation therapy
Moderate-to-severe mitral valve disease
Severe heart failure (New York Heart Association functional class III to IV at the time of enrollment)
Expected surgery for structural heart disease
Secondary atrial fibrillation (due to cardiac surgery, infection, or hyperthyroidism).
Follow-up 24 months
Primary endpoint Percentage of time in atrial fibrillation on 7 Holter-monitor recordings at 3, 6, 12, 18, and 24 months
(Only episodes of atrial fibrillation longer than 1 minute were included in the analysis)
Secondary endpoint(s) Freedom from any atrial fibrillation and freedom from symptomatic atrial fibrillation at 24 months of follow-up
Cumulative and per-visit burden of symptomatic atrial fibrillation
Time to first recurrence of atrial fibrillation after the blanking period
Atrial flutter longer than 1 minute
Quality of life was assessed at baseline and at 12 and 24 months with the use of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) physical-component summary score and mental-component summary score (both of which range from 0 to 100, with higher scores indicating greater well-being)
Details .
Brief summary: Ablation not superior to drugs 1st line for paroxysmal AF
PAPER: Radiofrequency Ablation as Initial Therapy in Paroxysmal Atrial Fibrillation
Date 25 Oct 2012
Journal N Engl J Med 2012; 367:1587-1595
Information In new PAF patients with no prior med treatment, ablation vs. drug therapy

-No significant difference between treatment groups in the cumulative burden of atrial fibrillation
(At 3, 6, 12, 18, and 24 months)

-Trend emerging by 2 years
--85% of free of AF in the ablation group vs.71% in the drug-therapy group

1) 36% of patients in the drug-therapy group had crossed over to receive ablation
2) Patiently highly selected (e.g. none > 70 y/o)
3) 3-month “blanking period” after ablation where attacks were not counted