Ablation vs Drug Therapy for Atrial Fibrillation - Pilot Trial

Inclusion Criteria: * Have documented AF, which warrants active drug or ablative treatment * Be eligible for both catheter ablation and at least 2 sequential anti-arrhythmic drugs and/or 3 sequential rate control drugs * Be \>65 yrs of age, or \<65 yrs with one or more of the following risk factors for stroke: Hypertension, Diabetes, Congestive heart failure (including systolic or diastolic heart failure), Prior stroke or transient ischemic attack, Left atrium \>4.5 cm, ejection fraction \<35% by echocardiogram, radionuclide evaluation or contrast ventriculography Exclusion Criteria: * Previously failed 2 or more membrane active anti-arrhythmic drugs * Efficacy failure of a full dose Amiodarone trial of \>12 weeks duration * Any amiodarone therapy in the past three months * Reversible causes of AF including thyroid disorders, acute alcohol intoxication, recent major surgical procedures, or trauma * Lone atrial fibrillation in the absence of risk factors for stroke in patients \<65 years of age * Recent cardiac events including myocardial infarction, percutaneous intervention, or valve or coronary bypass surgery in the preceding 3 months * Hypertrophic obstructive cardiomyopathy * Class IV angina or congestive heart failure * Planned heart transplantation * Other mandated anti-arrhythmic drug therapy * Heritable arrhythmias or increased risk for "torsade de pointes" (a specific, rare variety of ventricular tachycardia) with class I or III drugs * Prior left atrial catheter ablation with the intention to treat AF * Patients with other arrhythmias requiring ablative therapy * Prior surgical interventions for AF such as the MAZE procedure * Prior atrioventricular nodal ablation * Medical conditions limiting expected survival to \<1 year * Contraindication to warfarin anti-coagulation * Women of childbearing potential * Participation in any other clinical mortality trial * Unable to give informed consent