In patients with persistent atrial fibrillation, what clinical characteristics would lead you to offer pulsed field ablation as first-line therapy without a prior trial of anti-arrhythmic drugs?

Ablation is generally more effective at maintaining sinus rhythm than AADs and is an ambulatory procedure, so it is a good option for many patients. I discuss each of the options with my patients, including monitoring, rate control agents, AADs, DCCV, and ablation. I review that often multiple strat...

Generally speaking, the bar for offering an ablation as first-line therapy has been lowered with the availability of PFA. There are multiple factors that come into play in making the decision. Personally, I have a discussion with the patient to discuss the pros and cons of each option, including rat...

The key to successful management of AF is individualization. There clearly are some patients for whom ablation at first-line treatment makes sense. Generally, these patients present with a paroxysmal pattern, but if a patient with persistent AF has no evidence of advanced structural heart disease, i...