There have been several studies performed to investigate the role of AF ablation as first-line therapy, prior to a trial of a membrane-active antiarrhythmic medication.377,378,379 The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF)494 trial compared catheter ablation with AAD therapy for the first-line therapy of symptomatic PAF.378 The trial did not show a reduction in the cumulative AF burden over 2 years; however, catheter ablation was associated with a lower rate of AF recurrence (15% vs 29%, P =.004) and a similar rate of complications (17% vs 15%) compared with AAD. The unexpected result in the MANTRA-PAF might be explained by the ablation techniques with discretional circumferential ablation without confirmation of PVI with a circular mapping catheter as well as by the choice of reduction in AF burden on 7-day Holter as a primary endpoint. Reductions in AF burden on a short 7-day Holter can be difficult to demonstrate in a paroxysmal population. In the Radiofrequency Ablation versus Antiarrhythmic drugs as First-line Treatment of Paroxysmal AF (RAAFT-2) trial, PV antrum isolation was performed using irrigated-tip ablation catheters confirmed by recordings from a circular mapping catheter.379 The results of the RAAFT-2 demonstrated that AF or AT recurred in 55% of the catheter ablation group compared with 72% of the patients in the AAD group after a 2-year follow-up (P = .016).