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(Circulation. 2008;118:2488-2490.)
© 2008 American Heart Association, Inc.

Editorial

Apples and Oranges

Comparing Antiarrhythmic Drugs and Catheter Ablation for Treatment of Atrial Fibrillation

David J. Callans, MD

From the Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia.

Correspondence to David J. Callans, MD, Hospital of the University of Pennsylvania, Cardiovascular Division, 9.129 Founders Pavilion, 3400 Spruce St, Philadelphia, PA 19104. E-mail david.callans@uphs.upenn.edu

Key Words: Editorials • ablation • antiarrhythmia agents • atrial fibrillation

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Since the initial proof of concept that catheter ablation could prevent recurrent atrial fibrillation (AF), there has been a considerable evolution in the focus of studies to evaluate this therapy. Initial studies were typically single center and aimed at ablation of paroxysmal AF in healthy young patients, with a relatively superficial end point of absence of recurrent symptomatic AF (ie, monitoring was minimal) in short term follow up. Technique was emphasized, with each group trumpeting the superiority of the lesion strategy of the day. Through this experience, procedural complications have decreased and attention has been directed gradually to patients with more-established AF. Guidelines have been developed^1,2 to attempt to enforce more uniform descriptions of complications and success, with a focus on extensive monitoring for asymptomatic recurrence.

Article p 2498

Having demonstrated that ablation can provide short term-control of AF in well-selected patients with an acceptable risk of serious complications (at least in experienced centers), we are now in the second wave of evaluation of AF ablation: comparing ablation to antiarrhythmic drugs in various clinical situations. Although not without precedent, comparing interventional and medical therapy is difficult. Any proper comparison would measure both differential efficacy and risk. It is easy to identify serious complications of interventions; serious complications of medical therapy are rare and hard to recognize, particularly over the short duration of clinical trials.

In this context, the study by Jaïs and coworkers is an important step forward.³ Patients with documented paroxysmal AF for at least 6 months who had . . . [Full Text of this Article]