Pulmonary Vein Ablation Versus Amiodarone in the Elderly (PAVANE)

Inclusion Criteria:

• Age ≥ 70 years at moment of screening, able to sign informed consent.
• Documented paroxysmal AF in association with complaints in the last year, with at least 2 episodes of complaints attributed to AF in the previous 2 months.
• Paroxysmal AF documented with at least one ECG with sinus rhythm not after cardioversion in the last year.
• No prior use of amiodarone in the last 6 months and no usage longer than 4 weeks in total.

Exclusion Criteria:

• EF < 35 % or description of "poor left ventricular function" on echocardiogram. Measurement should not be older than 6 months at moment of screening.
• Aortic, mitral, pulmonary or tricuspid valve regurgitation or stenosis, if graded severe (grade >3)
• Acute illness: unstable angina, infectious disease.
• Primary structural or electrical heart disease: dilated cardiomyopathy, hypertrophic cardiomyopathy, Brugada syndrome, long QT syndrome.
• Reversible causes (thyroid dysfunction, uncontrolled hypertension, ischemia).
• Previous ablation or pacemaker.
• Contraindications for amiodarone; liver dysfunction (serum alanine aminotransferase >2.5 times upper limit); thyroid dysfunction; chronic lung disease; baseline QTc >460 ms. sinus node dysfunction (pause more than 3 seconds); second or third degree AV-block; left bundle branch block.
• Contraindications for anti-coagulation: prior life threatening hemorrhage under use of Vitamine K antagonists.
• Any myocardial infarction or PCI in previous 6 months.
• CABG in previous 6 months.
• Renal dysfunction: creatinin clearance <45 ml/min
• Severe co-morbidity. Life expectancy less than 1 year.
• Thrombus in left atrium
• Untreatable allergy to contrast media