A Prospective Study of Medical Therapy Against Cryoballoon Ablation in Symptomatic Recent Onset Persistent AF

Inclusion Criteria: * \> 21 years and legally capable * First documentation or history of symptomatic AF more than 30 sec within the last 2 years * Twice AF within the last year * One episode cardioverted after more than 48 hours or spontaneously terminated after more than 7 days * Eligible for at least one first step drug therapy (sotalol, propafenone, or flecainide) and for amiodarone * Left ventricular ejection fraction estimated \> 45% * LA diameter \< 50 mm (parasternal short axis) and LA volume less than 100 ml (apical view, Area Length method;) * CHADS2 ≤ 2 * Failed AAD strategy, or untreated with AAD * No use of Amiodarone in the previous 3 months (except IV or oral for 7 days) * Informed consent Exclusion Criteria: * Age \> 75 yrs * CHF * Ischemic heart disease as known in the history * (Severe) Left ventricular hypertrophy as shown on echo (IVSd or PWd \> 14 mm) * Hyperthyroidism * Congenital heart disease * Hypertrophic Cardiomyopathy, Arrhythmogenic Right ventricular Cardiomyopathy, channelopathies * Contra-indications to AAD * Long QT syndrome * Received already adequately dosed all level 1 drugs (sotalol, propafenone, and flecainide) * Pure (typical) atrial flutter as documented on one occasion