Early Ablation for Paroxysmal Atrial Fibrillation — Safety First

Catheter ablation of atrial fibrillation by means of pulmonary vein isolation has undergone substantial improvements in efficacy and safety since it was introduced 20 years ago, and it has become an established treatment for patients with symptomatic atrial fibrillation.1 Although clinical practice guidelines have generally recommended at least one trial course of antiarrhythmic drug therapy before consideration of ablation therapy, the 2014 U.S. guideline introduced a class IIa recommendation that “In patients with recurrent symptomatic paroxysmal AF [atrial fibrillation], catheter ablation is a reasonable initial rhythm-control strategy before therapeutic trials of antiarrhythmic drug therapy, after weighing the risks and outcomes . . .