We recommend catheter ablation of AF in patients who remain symptomatic following adequate trials of anti-arrhythmic drug therapy and in whom a rhythm control strategy remains desired. (Recommendation Strong, Quality Moderate)<br /><br />We suggest catheter ablation to maintain sinus rhythm in select patients with symptomatic atrial fibrillation and mild-moderate structural heart disease who are refractory or intolerant to &ge;1 antiarrhythmic medication. (Recommendation Conditional, Quality Moderate)<br /><br /><b>Values and preferences: </b>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.