TRIAL FIBRILLATION (AF) REPresents an important public health problem. Patients with AF have an increased longterm risk of stroke, heart failure, and all-cause mortality. [1][2][3][4] Furthermore, patients with AF describe a considerably impaired quality of life (QOL) that is independent of the severity of the disease. 5,6 Restoration and maintenance of normal sinus rhythm following treat-ment directly correlates with improved QOL in these patients. [5][6][7][8] Although antiarrhythmic drugs are generally used as first-line therapy to treat patients with AF, effectiveness remains inconsistent. The likelihood of AF recurrence within 6 to 12 months approaches 50% with most drugs. [9][10][11] Antiarrhythmic drugs are also associ-ated with cumulative adverse effects over time. 1 Catheter ablation has accordingly become an alternative therapy for AF. 12 Several recent studies have See also Patient Page.

ConclusionsSinus rhythm can be maintained long term in the majority of patients with chronic atrial fibrillation by means of circumferential pulmonary-vein ablation independently of the effects of antiarrhythmic-drug therapy, cardioversion, or both. The maintenance of sinus rhythm is associated with a significant decrease in both the severity of symptoms and the left atrial diameter.

Circumferential pulmonary vein ablation is more successful than ADT for prevention of PAF with few complications. Atrial fibrillation ablation warrants consideration in selected patients in whom ADT had already failed and maintenance of sinus rhythm is desired. (A Controlled Randomized Trial of CPVA Versus Antiarrhythmic Drug Therapy in for Paroxysmal AF: APAF/01; http://clinicaltrials.gov/ct/show; NCT00340314).

Pulmonary vein ablation improves mortality, morbidity, and QoL as compared with medical therapy. Our findings pave the way for randomized trials to prospect a wider application of ablation therapy for AF.