title: Catheter ablation of atrial fibrillation as first-line therapy--a single-centre experience.
abstract: OBJECTIVE
  The aims of the study were (i) to assess the characteristics of patients selected for atrial fibrillation (AF) ablation as first-line therapy, (ii) to identify current clinical criteria for such a strategy, and (iii) to analyse the outcome compared with patients who had failure of antiarrhythmic drug (AAD) therapy prior to ablation.
  
  
  RESULTS
  Consecutive patients undergoing ablation of AF were included in a prospective registry. Serial long-term electrocardiogram monitoring and clinical follow-up were performed after 3, 6, and 12 months. Out of 434 patients, 17% underwent AF catheter ablation as first-line therapy (AAD-), and 83% had undergone at least one AAD trial (AAD+). In AAD- patients, the reasons for this strategy were: (i) patient preference, n= 51 (71%); (ii) contra-indication to AAD, n= 21 (29%). Atrial fibrillation duration prior to ablation was shorter (52 ± 54 vs. 78 ± 81 months, P= 0.005), and the percentage of patients hospitalized for AF (32% vs. 48%, P= 0.01) was lower in AAD- patients. Long-term multiple procedure success rate (78% vs. 64%, P= 0.03) was higher in the AAD- group, and there were less repeat ablations in this group (21% vs. 38%, P= 0.01).
  
  
  CONCLUSIONS
  Catheter ablation was first-line therapy of AF in a significant number of patients, according either to patient preference or to medical factors, and this had important implications. Ablative therapy was performed at an earlier stage of the disease, and was associated with a significantly higher success rate and with a decreased need for repeat procedures.
authors.affiliation: Department of Cardiology, Inselspital, University Hospital, and University of Bern, Bern, Switzerland. hildegard.tanner@insel.ch
authors.forename: Hildegard
authors.initials: H
authors.lastname: Tanner
authors.forename: Karol
authors.initials: K
authors.lastname: Makowski
authors.forename: Laurent
authors.initials: L
authors.lastname: Roten
authors.forename: Jens
authors.initials: J
authors.lastname: Seiler
authors.forename: Nicola
authors.initials: N
authors.lastname: Schwick
authors.forename: Christian
authors.initials: C
authors.lastname: Müller
authors.forename: Jürg
authors.initials: J
authors.lastname: Fuhrer
authors.forename: Etienne
authors.initials: E
authors.lastname: Delacrétaz
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D012042:Registries / Q000706:statistics & numerical data