Catheter ablation of atrial fibrillation should be offered as primary therapy: what's your hurry?

The appropriate initial treatment of a middle-aged individual with symptomatic paroxysms of atrial fibrillation, diabetes, and hypertension should focus on eliminating the underlying causes of disease to safely reduce morbidity and prolong life. An initial strategy using ablation temporarily reduces arrhythmia symptoms and exposes the individual to potentially needless risk and repeat procedures. Randomized trials have not established the superiority of ablation to antiarrhythmic drugs with respect to prolonging life or reducing serious morbidity. It is appropriate to treat modestly symptomatic individuals with antiarrhythmic drugs while performing aggressive risk factor modification.