This is an interesting Medscape article. medscape.com/viewarticle/88...
A couple of statements made are:
"Look at which type of procedure is performed by your electrophysiologist. Pulmonary vein isolation alone is not enough."
"I think that today you have heard some very interesting clinical data. We all see AF. My biggest fear around AF is an emergency department that gives intravenous (IV) diltiazem, not knowing what is underneath that rhythm. The low-EF patients can really get hurt with IV diltiazem because it significantly drops cardiac output. I usually recommend that if you are in a hurry, give some IV metoprolol. Give it slowly right there at the bedside and stand there. You do not leave when you are giving IV anything. Try to cut down the rate that way, rather than with IV diltiazem."
"I think there is room for updating the guidelines. Right now [catheter ablation] for AF is recommended after failure of the drugs. My message to clinicians is to think about catheter ablation earlier rather than later. From our experience in the AATAC trial, we had a success rate range from 29% to 61%, according to the procedure performed and the operator performing the procedure."
Studies of course are studies and whether the conclusions apply to all patients is the big challenge.