Please select the eligibility criteria that correspond to the clinical trial below.
Title: Study of Ablation Versus antiaRrhythmic Drugs in Persistent Atrial Fibrillation
Brief Summary: The purpose of this study is to compare the effectivity and safety of atrial fibrillation ablation, in comparison to antiarrhythmic drug therapy in patients with refractory, persistent atrial fibrillation.


Options:
A: Inclusion Criteria:

* Patients with persistent atrial fibrillation (more than 7 days, or less than 7 days needing pharmacologic or electric cardioversion)

Exclusion Criteria:

* Hypo or hyperthyroidism
* Persistent atrial fibrillation lasting more than 1 year or non-defined duration
* Hypertrophic myocardiopathy
* Implantable defibrillation or pacemaker implanted
* Moderate or severe mitral valve disease or mitral prosthetic valve
* Ejection fraction less than 30%
* Left atrial anteroposterior diameter more than 50 mm.
* Previous atrial fibrillation ablation
* Contraindication to anticoagulation
* Left atrium thrombus
* Current infective disease or sepsis
* Pregnant women
* Current unstable angor
* Acute myocardial infarction in last 3 months
* Atrial fibrillation secondary to ionic disturbance, thyroids disease or secondary to any other reversible or non cardiovascular disease
* Reduced expectancy of life (less than 12 months)
* Patient participating in another clinical study that investigates a drug or device
* Psychologically unstable patient or denies to give informed consent
* Any cause that contraindicate ablation procedure or antiarrhythmic drug
B: Inclusion criteria:

* Age ≥ 18 years, \< 80years
* NYHA II-IV symptoms
* Impairment of left ventricular systolic function (left ventricular ejection fraction estimated as ≤ 35% by radionuclide ventriculography)
* Documented AF lasting for at least 7 days (persistent or permanent AF)

Exclusion criteria:

* CRT or ICD device implanted in the previous 6 months
* AV nodal ablation within previous 3 months
* Prior AV nodal ablation or complete heart block with a single chamber pacemaker
* Contraindication to anticoagulation
* Persistent thrombus in the left atrium despite anticoagulation
* Active malignancy
* Cerebrovascular accident within the previous 6 months
* Reversible causes of AF including thyroid disorders, alcohol, recent surgery
* Reversible causes of heart failure including acute myocarditis or alcohol
* Cardiac events including myocardial infarction (MI), percutaneous coronary intervention (PCI), valve or coronary bypass surgery within the previous 3 months
* Prior AF ablation procedure
* Previous heart transplant, or on urgent heart transplant waiting list
* Severe neuro-muscular disease
* Creatinine clearance \<30 ml/min
* Serum bilirubin \>50 micromol/L
* Active participation in another research study
* Unable to understand and comply with protocol or give written informed consent
* Body mass index \>35 (kg/m2)
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: A