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Paroxysmal Atrial Fibrillation — EECC MCQ

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ModerateArrhythmia & ElectrophysiologyParoxysmal Atrial FibrillationEECC

A 55-year-old woman with symptomatic paroxysmal atrial fibrillation (frequent episodes despite flecainide 100 mg twice daily) and no structural heart disease is reviewed in the arrhythmia clinic. Echocardiography shows normal LV function, LA diameter 38 mm. She has a CHA2DS2-VA score of 1. According to the 2024 ESC AF Guidelines, which of the following is an appropriate first-line rhythm control strategy?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Catheter ablation (pulmonary vein isolation)

Explanation lettering: D = shown as A · C = shown as B · A = shown as C · B = shown as D

The 2024 ESC AF Guidelines upgrade catheter ablation (PVI) to a first-line rhythm control option for suitable patients with paroxysmal AF, based on EARLY-AF, STOP AF First, and CRYO-FIRST trials. This patient has failed first-line AAD. Amiodarone (A) has significant long-term side effects. Dronedarone (D) is less effective than flecainide. Abandoning rhythm control (C) is not appropriate in a symptomatic patient. AV node ablation (E) is a last resort.

Reference: ESC (2024): Guidelines for the Management of Atrial Fibrillation