Atrial-fibrillation ablation should be considered first-line therapy for some patients.

PURPOSE OF REVIEW: Ablation for atrial fibrillation has become a widely accepted and practiced treatment for this arrhythmia. While this treatment has traditionally been reserved for second-line therapy in patients who have failed drug therapy, ablation is now being contemplated for first-line treatment. This review outlines the argument in favor of using ablation as first-line therapy for atrial fibrillation.

RECENT FINDINGS: Contrary to trials suggesting that rate control is equivalent to rhythm control, atrial fibrillation increases both morbidity and mortality. Unfortunately, drug-based therapy for atrial fibrillation is very ineffective and may also contribute adversely to both patient morbidity and mortality. Ablation has emerged as a curative therapy that addresses the root causes of atrial fibrillation. The technique for ablation has become quite consistent and the outcomes are far superior to those achievable by drug therapy. The complication risk is also acceptably low. There is also evidence to suggest that atrial-fibrillation ablation is superior to drug therapy as first-line treatment.

SUMMARY: Given all of the above-mentioned arguments, it is not unreasonable that atrial-fibrillation ablation be used as a first-line option for selected patients with this disease.