There is limited evidence to suggest which ablation method was the best .
There is limited evidence to suggest that CA may be a better treatment option compared to medical therapies in the management of persistent AF .
This review was also unable to recommend the best CA method
BACKGROUND Atrial fibrillation ( AF ) is the most common cardiac arrhythmia seen in cardiovascular departments .
Treatments include medical interventions and catheter ablation .
Due to uncertainties in medical therapies for AF , and the need to continue sinus rhythm , ablation has been recently considered as a viable alternative .
Many new ablation methods based on pulmonary vein isolation ( PVI ) have been developed .
OBJECTIVES The primary objective of this review was to assess the beneficial and harmful effects of  catheter ablation ( CA ) in comparison with medical treatment in patients with paroxysmal and persistent AF .
The secondary objective was to determine the best regimen of CA .
Achievement of pulmonary vein isolation in patients undergoing circumferential pulmonary vein ablation: a randomized comparison between two different isolation approaches.
INTRODUCTION Circumferential pulmonary vein ablation ( CPVA ) with the endpoint of pulmonary vein ( PV ) isolation has been developed as an effective therapy for atrial fibrillation ( AF ) . This endpoint can be achieved either by closing gaps along circular lines or by segmental PV isolation inside the circular lines after creation of initial CPVA lesions . We investigated whether the clinical outcome depends on the PV isolation approach used during the first-time CPVA procedure . METHODS AND RESULTS One hundred consecutive patients ( 69 male ; age , 56.7 + /- 11.6 years ) who underwent first-time CPVA for treatment of symptomatic AF were enrolled . PV isolation was r and omly achieved either by CPVA alone ( aggressive CPVA [ A-CPVA ] group , n = 50 ) or by a combination of CPVA with segmental PV ostia ablation ( modified CPVA [ M-CPVA ] group , n = 50 ) . Recurrence of atrial tachyarrhythmias ( ATa ) within 3 months after the initial procedure occurred in 30 patients ( 60 % ) in the M-CPVA group and in only 15 patients ( 30 % ) in the A-CPVA group ( P < 0.01 ) . ATa relapse after the first 3 months was detected in 21 patients ( 42 % ) in the M-CPVA group , compared with 9 patients ( 18 % ) in the A-CPVA group ( P = 0.01 ) . At 13 + /- 4 months , patients treated by the A-CPVA approach had greater freedom from ATa recurrence than patients who underwent M-CPVA ( P = 0.01 ) . The M-CPVA approach was the only independent predictor associated with procedural failure ( RR 0.318 ; 95 % CI 0.123 - 0.821 ; P = 0.02 ) . CONCLUSIONS When PV isolation is the endpoint of CPVA , the efficacy of the A-CPVA approach is better than that of M-CPVA
There is limited evidence to suggest which ablation method was the best .
There is limited evidence to suggest that CA may be a better treatment option compared to medical therapies in the management of persistent AF .
This review was also unable to recommend the best CA method
BACKGROUND Atrial fibrillation ( AF ) is the most common cardiac arrhythmia seen in cardiovascular departments .
Treatments include medical interventions and catheter ablation .
Due to uncertainties in medical therapies for AF , and the need to continue sinus rhythm , ablation has been recently considered as a viable alternative .
Many new ablation methods based on pulmonary vein isolation ( PVI ) have been developed .
OBJECTIVES The primary objective of this review was to assess the beneficial and harmful effects of  catheter ablation ( CA ) in comparison with medical treatment in patients with paroxysmal and persistent AF .
The secondary objective was to determine the best regimen of CA .