Inclusions / Exclusions:
Patients who have new onset or under-treated paroxysmal, persistent, or longstanding persistent atrial fibrillation and who warrant therapy for their arrhythmia will be considered for enrollment.
- Have paroxysmal AF episodes ≥1 hour in duration; with ≥2 episodes over the preceding 6 months with electrocardiographic documentation of at least 1 episode; or 1 persistent or longstanding persistent episode of AF lasting more than 1 week.
- Warrant active therapy beyond simple ongoing observation
- Be eligible for catheter ablation and ≥2 sequential rhythm control and/or ≥3 rate control drugs.
- Be ≥65 yrs of age, or <65 yrs with one or more of the following risk factors for stroke:
- Hypertension (treated and/or defined as a BP >140/90 mmHg) ,
- Diabetes (treated and/or defined as a fasting glucose ≥126 mg/dl) ,
- Congestive heart failure (including systolic or diastolic heart failure),
- Prior stroke or TIA, LA size >5.0 cm (or volume index ≥40 cc/m2), or EF ≤35.
- Subjects <65 yrs of age whose only risk factor is hypertension must have a second risk factor or LV hypertrophy to qualify.
- Have the capacity to understand and sign an informed consent form.
- Be ≥18 years of age.
If a subject has any of the following criteria, he or she may not be enrolled in the study:
- Lone AF in the absence of risk factors for stroke in patients <65 years of age
- Patients who in the opinion of the managing clinician should not yet receive any therapy for AF
- Patients who have failed >2 membrane active anti-arrhythmic drugs at a therapeutic dose due to inefficacy or side effects
- More than one week of amiodarone treatment in the past 3 months
- An efficacy failure of full dose amiodarone treatment >12 weeks duration at any time
- Reversible causes of AF including thyroid disorders, acute alcohol intoxication, recent major surgical procedures, or trauma
- Recent cardiac events including MI, PCI, or valve or bypass surgery in the preceding 3 months
- Hypertrophic obstructive cardiomyopathy (outflow track)
- Class IV angina or Class IV CHF (including past or planned heart transplantation)
- Other arrhythmias mandating anti-arrhythmic drug therapy (i.e. VT, VF)
- Heritable arrhythmias or increased risk for torsade de pointes with class I or III drugs
- Prior LA catheter ablation with the intention of treating AF
- Prior surgical interventions for AF such as the MAZE procedure
- Prior AV nodal ablation
- Patients with other arrhythmias requiring ablative therapy
- Contraindication to appropriate anti-coagulation therapy
- Renal failure requiring dialysis
- Medical conditions limiting expected survival to <1 year
- Women of childbearing potential (unless post-menopausal or surgically sterile)
- Participation in any other clinical mortality trial (Participation in other non-mortality trials should be reviewed with the clinical trial management center)