Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Randomized, Controlled Clinical Trial of Catheter Cryoablation in the Treatment of Paroxysmal Atrial Fibrillation.
Brief Summary: This study (STOP AF) is a prospective, randomized, controlled, multicenter, pivotal clinical investigation conducted at 26 investigational sites in the United States and Canada. Subjects with paroxysmal atrial fibrillation (PAF) referred for ablative intervention after efficacy failure of one or more Study Atrial Fibrillation (AF) Drugs (flecainide, propafenone or sotalol) were randomized 2:1 to cryoablation intervention (Experimental Subjects, ES) or to a Study AF Drug (Control Subjects, CS). Subjects were followed for 12 months with scheduled and symptom-driven assessments to detect recurrent atrial fibrillation by means of periodic electrocardiograms, weekly scheduled trans-telephonic monitoring, patient-initiated trans-telephonic monitoring, and 24-hour Holter monitoring at 6 and 12 months. The first 90 days after study therapy was initiated was considered a blanked period for all subjects.


Options:
A: Inclusion Criteria:

* Patients ≤ 70 years of age
* Paroxysmal atrial fibrillation patients who are considered as being candidates for antiarrhythmic drug therapy initiation
* Patients who have had at least two episodes of symptomatic paroxysmal atrial fibrillation in the foregoing 6 months can be included. The atrial fibrillation episodes may be persistent (need DC- or AAD-conversion) with a duration of less than 7 days.

Exclusion Criteria:

* Previous or ongoing chronic treatment with class IC or class III antiarrhythmic drugs
* Intolerance/contraindication to class IC and class III antiarrhythmic drugs (i.e. intolerance/contraindication to only one of the two groups is not excluding the patient)
* Previous atrial fibrillation ablation
* Severely increased left atrial size
* Left ventricular ejection fraction below 0.40 (during sinus rhythm or atrial fibrillation with RR-intervals above 600 ms) or "eye-balled" reduction of systolic function to less than "moderately decreased".
* Contraindication to anticoagulation treatment with vitamin K antagonists
* Expected surgery for structural heart disease within the follow-up period Significant mitral valve disease
* New York Heart Association (NYHA) III-IV
* Planned pregnancy within the follow-up period
* Secondary atrial fibrillation (e.g. post-surgery, infections, hyperthyroidism)
* Age \< 18 years
* Patient does not want to participate.
B: Inclusion Criteria:

1. Age 18-70 years
2. History of symptomatic paroxysmal AF lasting more than 6 months. Paroxysms of AF are intended as recurrent self-terminating episodes lasting less than 7 days and occurring more than 2 times every month.

Exclusion Criteria:

1. Pregnancy
2. NYHA functional class III or IV
3. Left atrial size \> 65 mm
4. Left ventricular (LV) ejection fraction \< 35%
5. Contraindication to anticoagulation with warfarin
6. History of myocardial infarction within six months of the procedure
7. Prior catheter or surgical ablation attempt for AF
8. Inability or unwillingness to provide written informed consent
9. Life expectancy less than 1 year
10. Significant comorbid conditions such as: cancer (not cured), end stage renal disease (creatinine clearance \< 20 mL/h), severe chronic obstructive lung disease, cirrhosis, etc)
11. Anticipated cardiac surgery for congenital, valvular, aortic or coronary heart disease.
12. Presence of left atrial thrombus.
13. Prior antiarrhythmic drug therapy with amiodarone, sotalol and flecainide at optimal doses (target 200 mg, 240 mg, 200 mg daily respectively
14. AF burden \< 2 episodes/month
15. WPW
16. Expected survival \< 1 year
17. Contraindications for antiarrhythmics therapy including flecainide, sotalol or amiodarone not listed above:

    * LV hypertrophy (LV mass index \> 125g/m2)
    * thyroid dysfunction (hyperthyroidism or uncontrolled hypothyroidism or thyroid cancer)
    * liver dysfunction (ALT or AST \>2x the reference values)
    * Interstitial lung disease with DLCO\<70% of predicted or severe asthma.
    * QT interval exceeding 400 msec
    * Symptomatic sinus node or atrioventricular node dysfunction unless a pacemaker had been implanted
    * Evidence of stress-induced myocardial ischemia
C: Inclusion Criteria:

* Documented Paroxysmal Atrial Fibrillation (PAF): PAF diagnosis, 2 episodes of PAF within the last 2 months, at least 1 episode of PAF must be documented
* Age 18-75
* Documented Effectiveness Failure of one (1) AF drug
* Willing to be randomized to either group and do full 12 month follow-up
* Able to follow standardized AF drug protocol

Exclusion Criteria:

* Any cardioversion within 3 months or more than 2 within 2 years
* Amiodarone within 6 months
* LA size \> 5.0cm
* Previous LA ablation/surgery, structural heart disease, heart failure class III or IV
* Hypertrophic cardiomyopathy, Mitral prosthesis
* Unstable angina, uncontrolled hyperthyroidism
* Stroke or TIA within 6 months, MI within 2 months, cardiac surgery within 3 months
* Thrombocytosis, thrombocytopenia
* Any condition contraindicating chronic anticoagulation
* EF \<40%
* Pregnancy
* Life expectancy \<1year
D: Inclusion Criteria:

* 18 years of age or older
* Paroxysmal atrial fibrillation for at least 6 months with at least 2 symptomatic episodes (patient history) during the previous month
* Atrial fibrillation (patient history or echocardiogram documented) resistant to at least one antiarrhythmic drug of Class I or III
* Documentation of at least one episode of atrial fibrillation on 12-lead echocardiogram or Holter Monitor

Exclusion Criteria:

* Contraindications to more than 2 antiarrhythmic drugs of different classes, or to oral anticoagulants
* History of any previous ablation for atrial fibrillation
* Intracardiac thrombus
* Atrial fibrillation due to reversible cause
* Pregnancy
* Contraindication to stopping oral anticoagulation (for example as a result of a mechanical cardiac valve)

Answer: C