.. Footnotes 1. http://www.mirbase.org/cgi-bin/mirna_summary.pl?org = hsa order Rapamycin 2. http://www.microrna.org/microrna/home.do 3. The human microRNA disease database (HMDD), http://202.38.126.151/hmdd/mirna/md/

The RAAFT-2 trial was a multicentre randomised clinical trial that was sponsored and co-ordinated by the Population Health Research Institute at McMaster University and an unrestricted research grant from Biosense Webster. It randomised 127 drug- & ablation-naive patients aged 18–75 with pAF to either first line catheter ablation (n = 66), or medical therapy (n = 61). Subjects were randomised in a 1:1 ratio to either treatment if they were symptomatic

with recurrent pAF, and had ≤ 4 episodes within the previous 6 months, one of which had to be documented by surface electrocardiography (ECG). All patients had normal systolic function and no history of heart failure or hypertension. At baseline there were two significant differences between the study group characteristics; previous electrical cardioversion

(33.3% RFA group vs 52.5% AAM group, p = 0.03) and use of oral anticoagulation (53% RFA group vs 31.1% AAM, p = 0.01). After randomisation patients entered a 90-day blanking period during which medications were titrated or ablation was performed. After this period, primary outcome events were recorded. Patients were followed up at 1, 3, 6, 12 and 24 months. The study also utilised transtelephonic monitoring (TTM) to assess the cardiac rhythm of patients biweekly and whenever subjects experienced symptoms of possible AF. RFA involved circumferential isolation of the pulmonary veins with confirmation of entrance block. Additional lesions were left to investigator discretion. AAM’s and cardioversions were allowed during the 90-day blanking period only. Patients randomised to the AAM group had their medications selected according to investigator

discretion, with doses being based on guidelines. 1 Patients in this group were able to undergo RFA after the 90-day treatment period if AAM had failed. This was demonstrated Carfilzomib by either drug discontinuation due to intolerance, adverse events or inefficacy (recurrence of pAF or atrial tachyarrhythmia lasting >30 seconds). The primary efficacy outcome was time to first recurrence of symptomatic or asymptomatic atrial arrhythmia lasting more than 30 seconds, as documented by ECG or TTM. Secondary outcomes included first documented recurrence of AF-related atrial arrhythmia, repeated episodes of AF-related atrial arrhythmia, and quality of life at the 1-year follow-up. The study was powered to test the superiority of RFA over AAD using cox regression analysis, stratified by clinical site. The Primary Safety Outcome was defined as the comparison of the proportion of patients with an occurrence of a cluster of serious complications in the RFA or AAM arms.