Given recent trials for the management of atrial fibrillation with an early ablation strategy (for example, EAST-AFNET 4, EARLY-AF, PROGRESSIVE-AF, STOP-AF), what is your approach to determining the appropriate timing for ablation in patients with atrial fibrillation?

I agree with Dr. @Dr. First Last. I also usually start with an antiarrhythmic drug and then offer ablation if the drug is not tolerated or is ineffectual. This is a shared decision-making process - some patients want nothing to do with drugs and prefer ablation and others want to try multiple drugs ...

In agreement with what has been said already, I will add that treatment of atrial fibrillation should be geared around symptoms, systolic function, and stroke risk with options of antiarrhythmic medications, anti-tachycardia pacing for those who meet indications for devices, and ablation for the fir...

I am a strong believer in the value of sinus rhythm. Whether it is restored and maintained with drugs or ablation is up to patient preference. Given the long wait times for ablation I almost always start with an anti-arrhythmic. If not effective or tolerated move on to ablation. If a patient has lit...

What is often forgotten is that even in "perfect" patients of ablation is NOT perfect. The improved outcomes noted with ablation strategies vs. medical therapy is a group win-not necessarily all individual patients. I agree with Dr. @Dr. First Last that in general sinus rhythm is better than atrial ...

I very much agree with what everyone has said. These answers are very helpful.

I also believe that restoring sinus rhythm is the goal. I also engage in a shared decision-making process. If patients have modifiable risk factors (obesity, sedentary lifestyle, uncontrolled diabetes, sleep apnea, Hyper...