OBJECTIVES: Atrial Fibrillation (AF) is the most common arrhythmia among the elderly. It has dire consequences, stroke being the most catastrophic. Its burden is highly significant; changing demographics lead to more patients impacted. Managing AF encompasses arrhythmia control and stroke prevention – with new technologies being developed for both. For Paroxysmal AF (PAF) – which terminates spontaneously within 7 days – electrical Pulmonary Vein Isolation (PVI) has advanced as the cornerstone treatment in patients unresponsive to pharmaceuticals. PAF accounts for 75% of patients, and half are medicated with sub-optimal outcomes. We sought to evaluate the cost-effectiveness of PVI when using a new balloon-based catheter using cooling energy for lesion creation (Arctic Front, Medtronic).  METHODS: A Markov Microsimulation Model compared treatment with Arctic Front vs. conventional drugs. STOP-AF Pivotal Trial Data were used to estimate PVI efficacy and complication rates. A literature review identified data for long-term PVI and drug therapy outcomes. The model incorporated Arctic Front specific complication rates (e.g. stroke, tamponade and phrenic nerve paralysis) and drug toxicities and impact on stroke risk was included. Utility weights were assigned for various health states. and a range of time horizons was used, with a UK perspective adopted for costs and benefits. One-way and probabilistic sensitivity analyses were undertaken. RESULTS: Depending on the time horizon, the ICER ranged from £3,200/QALY to £15,700/QALY gained. Results were sensitive to assumptions regarding long-term outcomes and the quality of life benefit of remaining free of PAF. CONCLUSIONS: PVI can be highly cost-effective in treating PAF – a highly prevalent and burdensome disease. Results are consistent with similar technology economic evaluations, and reinforce the evidence base for PVI as a cost-effective therapy for PAF.