Catheter ablation as a first-line AF therapy: the RAAFT-2 trial

Radiofrequency catheter ablation reduces the rate of atrial fibrillation (AF) recurrence to a greater extent than antiarrhythmic drug therapy when used as first-line therapy for paroxysmal

AF, according to the results of the randomized, multicentre RAAFT-2 trial. Current international guidelines recommend catheter ablation only as a second-line therapy for AF, when treatment

with at least one antiarrhythmic agent has been unsuccessful.

In the RAAFT-2 trial, patients aged 18–75 years who had experienced four episodes or fewer of AF within the previous 6 months, and had not received any antiarrhythmic agents, were randomly

assigned to undergo catheter ablation with complete pulmonary vein isolation (n = 66) or drug therapy (n = 61). The choice of antiarrhythmic drug and the dose was determined by the treating

physician and based on guideline recommendations. Flecainide was prescribed to 69.0% of patients, 25.0% received propafenone, and 16.4% received more than one type of drug. Three patients

(4.9%) crossed over to ablation during the study period. In the catheter-ablation group, the procedure was successful in 87.0% of patients, and 13.6% underwent a second ablation.

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