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(Circulation. 2005;112:1214-1230.)
© 2005 American Heart Association, Inc.

Controversies in Cardiovascular Medicine

Should atrial fibrillation ablation be considered first-line therapy for some patients?

Why Atrial Fibrillation Ablation Should Be Considered First-Line Therapy for Some Patients

Atul Verma, MD; Andrea Natale, MD

From the Section of Cardiac Pacing and Electrophysiology, Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio (A.V., A.N.), and The Care Group, LLC, Indianapolis, Ind (B.J.P., E.N.P.).

Correspondence to Andrea Natale, MD, Co-Section Head of Pacing and Electrophysiology, Co-Chairman Center for Atrial Fibrillation, Cleveland Clinic Foundation, Desk F 15, 9500 Euclid Ave, Cleveland, OH 44195. (e-mail natalea@ccf.org); or Eric N. Prystowsky, MD, FACC, The Care Group, LLC, 8333 Naab Rd, No. 400, Indianapolis, IN 46260 (e-mail eprystow@thecaregroup.com).

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

	Introduction

 
Atrial fibrillation (AF) is an increasingly common disease that affects patient morbidity and mortality. To date, treatments of AF have been frustrating, serving at best to palliate this arrhythmia. AF ablation, on the other hand, has emerged as a promising new treatment strategy. In contrast to rate control or antiarrhythmic drugs, ablation offers the possibility of a lasting cure. When ablation was first described, it was prudently reserved as a "last-line" treatment for highly symptomatic patients who were refractory to all other options. However, over the past 5 years, many centers worldwide have been reporting high success rates and few complications with ablation. There is also an increasing consistency in the way in which the procedure is performed, although some of the tools may still differ. AF ablation has reached "prime time," and it appears appropriate that we expand its indications.

We believe that it is now appropriate to offer AF ablation as first-line therapy for selected patients in experienced centers. Here, we stress the importance of maintaining sinus rhythm, the poor efficacy of nonablative treatments, and the emergence of an effective and safe approach to AF ablation.

	The Importance of Sinus Rhythm

 
Recently, the importance of maintaining sinus rhythm has been called into question. A few large clinical trials have been published comparing treatment strategies for AF. In particular, the AF Follow-up Investigation of Rhythm Management (AFFIRM),¹ Rate Control Versus Electrical Cardioversion for AF (RACE),² and Strategies for Treatment of AF (STAF)³ trials compared a strategy of rate control and a rhythm control approach . . . [Full Text of this Article]

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