Recommendation 1 – Catheter ablation in symptomatic drug-refractory patients (2014)
We recommend catheter ablation of AF in patients who remain symptomatic following an adequate trial of antiarrhythmic drug therapy and in whom a rhythm control strategy remains desired. (Strong Recommendation, Moderate Quality Evidence).

Values and Preferences (2014)
This recommendation recognizes that failure of multiple antiarrhythmic drugs results in few alternative strategies if maintenance of sinus rhythm is preferred based on symptom burden reduction and quality of life improvement.

Recommendation 2 – Catheter ablation as first-line therapy in highly selected patients (2014)
We suggest catheter ablation to maintain sinus rhythm as first-line therapy for relief of symptoms in highly selected patients with symptomatic, paroxysmal atrial fibrillation (Conditional Recommendation, Moderate Quality Evidence).

Values and Preferences (2014)
This recommendation recognizes that individual patients may have a strong intolerance or aversion to antiarrhythmic drugs such that the risk of ablation is deemed warranted.

Recommendation 3 – Catheter ablation only by operators with expertise and high volumes (2014)
We suggest that catheter ablation of AF should be performed by electrophysiologists with a high degree of expertise and high annual procedural volumes (Conditional Recommendation, Low Quality Evidence).

Values and Preferences (2014)
This recommendation recognizes that the risks of catheter ablation are directly related to operator experience and procedural volume at a given center. Although it is difficult to specify exact numerical values, the threshold seems to be 25-50 procedures/operator/year.

Recommendation 4 – Curative catheter ablation as first-line therapy for typical atrial flutter (2010)
We recommend curative catheter ablation for symptomatic patients with typical atrial flutter as first line therapy or as a reasonable alternative to pharmacologic rhythm or rate control therapy (Strong Recommendation, Moderate Quality Evidence).

Values and preferences (2010)
This recommendation recognizes the high efficacy, low complication rate of catheter ablation and low efficacy of pharmacologic therapy, whether rate or rhythm control. 20

Recommendation 5 – Catheter ablation of accessory pathway (2010)
In patients with evidence of ventricular preexcitation during AF, we recommend catheter ablation of the accessory pathway, especially if AF is associated with rapid ventricular rates, syncope, or a pathway with a short refractory period (Strong Recommendation, Low Quality Evidence).

Values and preferences (2010)
This recommendation places a high value on the prevention of sudden cardiac death in patients at high risk and a low value on the small complication rate of catheter ablation of the accessory pathway.

Recommendation 6 - Exclude reentrant tachycardia in young patients with lone paroxysmal AF (2010)
In young patients with lone, paroxysmal AF, we suggest an electrophysiological study to exclude a reentrant tachycardia as a cause of AF; if present, we suggest curative ablation of the tachycardia (Conditional Recommendation, Very Low Quality Evidence).

Values and preferences (2010)
This recommendation recognizes that supraventricular tachycardia can initiate AF when the substrate for AF is present and can be ablated with a high success rate and minimal risk.