Ablation for Treatment-Naive A-Fib Patients?

In this study, Danish researchers randomized 294 treatment-naive patients with paroxysmal atrial fibrillation to receive either radiofrequency catheter ablation or standard therapy with class IC or class III antiarrythmic drugs. At 2 years, the burden of a-fib was significantly lower in those receiving ablation than in those receiving antiarrythmic drug therapy (90th percentile, 9% vs. 18%; P=0.007). Three patients in the ablation group had cardiac tamponade related to the procedure. One patient in the ablation group died from a procedure-related stroke. About a third of the patients in the drug treatment group underwent supplementary ablation. An accompanying editorial can be found here. How does your study change which patients with A-fib you consider for ablation in your own practice?  The MANTRA-PAF trial documents that antiarrhythmic drug treatment is pretty effective in a large proportion of patients with paroxysmal a-fib, most notably relatively young patients without much comorbidity. Therefore, we still advise the majority of our patients to try at least one antiarrhythmic drug as the initial therapy. However, the study also shows that radiofrequency ablation is at least as effective as drug therapy. Thus, we offer ablation as initial therapy as an option for younger, healthier patients. Further analysis of these data may help to clarify which patients are most suitable for initial therapy with ablation versus drug therapy. Are these results generalizable given the...
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