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Pulmonary vein isolation was better than antiarrhythmic drugs for symptomatic atrial fibrillation

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 Q In patients with symptomatic atrial fibrillation (AF), is pulmonary vein isolation (PVI) with radiofrequency ablation more effective than antiarrhythmic drugs as first line treatment?

Clinical impact ratings Internal medicine ★★★★★★☆ Cardiology ★★★★★★★


Embedded ImageDesign:

randomised controlled trial.

Embedded ImageAllocation:


Embedded ImageBlinding:


Embedded ImageFollow up period:

1 year.

Embedded ImageSetting:

44 clinical centres in Italy and 26 clinical centres in Germany.

Embedded ImagePatients:

70 patients who were 18–75 years of age and had experienced monthly symptomatic AF ⩾3 months. Exclusion criteria included previous history of AF or AF ablation, previous treatment with antiarrhythmic drugs, and contraindication to long term anticoagulation.

Embedded ImageIntervention:

33 patients were allocated to PVI with radiofrequency ablation (all 4 pulmonary veins were isolated) and were given ⩾3 months of warfarin, beginning on the evening of PVI (target international normalised ratio [INR] of 2–3). If patients …

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  • * Information provided by author.

  • See glossary.

  • For correspondence: Dr A Natale, Cleveland Clinic Foundation, Cleveland, OH, USA. natalea{at}

  • Source of funding: Acuson (division of Siemens Medical Solutions).

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