November 2009
This guide summarizes the clinical evidence on the effectiveness and safety of catheter-based
radiofrequency ablation (RFA) compared with anti-arrhythmic drugs (AADs) for the treatment of atrial
fibrillation (AF). This guide does not address other aspects of AF treatment, including anticoagulation,
rate control medications, or treatments other than RFA and AADs used to restore sinus rhythm.
Clinical Bottom Line
n Evidence is insufficient to determine the
effectiveness of RFA as first-line therapy compared
with AADs.
n Among patients with AF who have failed at least
one course of AADs, RFA is more effective than
another trial of AADs for maintaining sinus
rhythm at 1 year.
LeveL of ConfidenCe: ● ● ●
n Serious complications are uncommon after RFA,
but stroke and cardiac tamponade each occur in
about 1 percent of cases.
LeveL of ConfidenCe: ● ● ●
Confidence Scale
The confidence ratings in this guide are derived from a system-
atic review of the literature. The level of confidence is based on
the overall quantity and quality of clinical evidence.
HigH ● ● ● There are consistent results from good quality
studies. Further research is very unlikely to change the
conclusions.
MediuM ● ● ● Findings are supported, but further research
could change the conclusions.
Low ● ● ● There are very few studies, or existing studies
are flawed.
Clinical Issue
Atrial fibrillation (AF) is the most common sustained
cardiac arrhythmia. AF can be paroxysmal, persistent
(more than 7 days), or chronic (more than 1 year). AF
often causes significant symptoms, such as palpitations,
shortness of breath, and fatigue, and is associated with
a fivefold increased risk of stroke and approximately a
twofold increased risk of death. Many people with AF
can be adequately treated with drugs that control heart
rate without restoring normal heart rhythm. However,
for some people, rate control alone does not relieve the
symptoms. Those people may benefit from therapies to
restore normal cardiac rhythm. Sometimes