Ablation vs antiarrhythmic drugs, which is better for atrial fibrillation? This has been a dilemma facing the cardiac electrophysiologist ever since pulmonary vein ablation for atrial fibrillation was in vogue. Now we have an anwser to this question from a randomized multicentric trial by Pierre Jaïs and colleagues Circulation. 2008;118:2498-2505. They randomized 112 patients with paroxysmal atrial fibrillation resistant to at least 1 antiarrhythmic drug to either ‘new’ antiarrhythmic drugs or catheter ablation. Crossover from the antiarrhythmic drugs to ablation group occurred in 37% while the reverse cross over took place only 9% (P=0.0001). Crossover was permitted at 3 months in case of failure of therapy in question. At one year follow up, 89% in the ablation group had no recurrence while only 23% in the antiarrhythmic group was free of recurrence (P<0.0001). Ablation group had significantly better symptom score, exercise capacity and quality of life. Upto three ablation procedures or changes in antiarrhythmic drugs in three months were permitted in evaluating the primary end point of recurrence of atrial fibrillation between three months and twelve months. The authors conclude that this trial has demonstrated the superiority of catheter ablation over antiarrhythmic drugs in patients with atrial fibrillation regarding the maintenance of sinus rhythm and improvement in symptoms, exercise capacity, and quality of life.