In this large randomized trial of patients with symptomatic paroxysmal Afib, they were randomized to treatment with radiofrequency ablation, or Class IC / III anti-arrhythmics. There was no difference in rates of freedom from Afib between the groups at up to 18 months follow up, but the rates at 24 months were lower in the ablation group (93% vs 84%). However, in the ablation group, there was 1 procedure-related death, and 3 cases of tamponade. Given the risks, anti-arryhthmics should be tried before ablation in patients with symptomatic paroxysmal Afib. (abstract)
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