Comparison of rhythm restoration strategies in paroxysmal atrial fibrillation.

Evaluation of: Wilber DJ, Pappone C, Neuzil P et al.; ThermoCool AF Trial Investigators. Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial. JAMA 303(4), 333-340 (2010). Atrial fibrillation is the most common cardiac arrhythmia and is responsible for the highest number of cardioembolic strokes worldwide. Discovery of the role of pulmonary veins as a trigger has been an important breakthrough that has led to the development of catheter ablation, an established curative therapy for drug-resistant atrial fibrillation. In a systematically conducted prospective, multicenter, randomized trial comparing pulmonary vein isolation-based catheter ablation with pharmacological rhythm control, the currently recommended first-line therapy in atrial fibrillation, catheter ablation, proved superior to antiarrhythmic drugs with regards to the maintenance of sinus rhythm and improvement in symptoms and quality of life at 1 year of follow-up, with comparable adverse event rates. Early use of catheter ablation in selected patients with paroxysmal atrial fibrillation unresponsive to one antiarrhythmic drug is promising.