OBJECTIVES: Atrial Fibrillation (AF) is the most common arrhythmia associated with a variety of cardiovascular conditions and increased rates of stroke, death. The aim of this study was to critically evaluate the current evidence on the use of radiofrequency catheter ablation (RFCA) for rhythm control compared with antiarrhythmic drug (AAD) therapy in patients with AF. METHODS: We searched potentially relevant studies using electronic databases such as Ovid-Medline, Ovid-EMBASE, Cochrane library, and seven Korean medical databases through May 2012. Two independent reviewers extracted data from each study using a standardized form. Disagreements between reviewers were resolved by discussion or in consultation with a third reviewer. The quality of the selected studies was assessed using the Cochrane risk of bias for randomized controlled trials (RCTs). A random-effects model was used to combine trials and the dichotomous data were presented as relative risk (RR) with 95% confidence intervals (CI).  RESULTS: A total of 10 studies (8 RCTs) representing 930 patients were included. Their methodological quality was mostly poor. RFCA, in comparison with AAD therapy, significantly increased freedom from atrial tachycardia/AF (RR 3.06, 95% CI 2.34-3.99, P<0.00001, I2=55%) in 8 RCTs at one year follow-up. There was no difference in all-cause mortality (4 RCTs, RR 0.76, 95% CI 0.18-3.19, P=0.71, I2=0%). Also, the rates of stroke/transient ischemic attack between both groups was insignificant (RR 1.95, 95% CI 0.34-11.04, P=0.83, I2=0%). Fewer complications were reported in the RFCA group compared with AAD group (RR 0.68, 95% CI 0.37-1.23, I2=45%). CONCLUSIONS: There is limited evidence to suggest that RFCA may be a better rhythm control treatment option compared to AAD therapy in patient with AF. Further rigorous RCTs with long-term follow up that overcome the many limitations of the current evidence are warranted.