title: Comparison of rhythm restoration strategies in paroxysmal atrial fibrillation.
abstract: 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.
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, 33604 Bordeaux-Pessac, France.
authors.forename: Ashok J
authors.initials: AJ
authors.lastname: Shah
authors.forename: Michel
authors.initials: M
authors.lastname: Haissaguerre
authors.forename: Meleze
authors.initials: M
authors.lastname: Hocini
authors.forename: Pierre
authors.initials: P
authors.lastname: Jais