This editorial refers to ‘The right recommendations for the wrong reasons?’ by M. Duytschaever et al ., on page 615 In a separate editorial that was published ahead of print on 23 January 2013, Belgian cardiologists comment on a health technology assessment (HTA) on catheter ablation of atrial fibrillation (CA-AF) that we prepared at the Belgian Health Care Knowledge Centre (KCE).1 We would like to thank the editor of Europace to provide us the opportunity to rebut our colleagues' contentions. In contrast to the claims made by Duytschaever et al ., our HTA report does not limit itself to an evaluation of administrative data. We performed a systematic review of the literature on the clinical effectiveness, the safety, and the cost effectiveness of CA-AF. We critically appraised randomized controlled trials (RCTs) that compared catheter ablation with antiarrhythmic drug (AAD) treatment, as well as recent observational studies.2,3 The variation in the clinical effectiveness of CA-AF reported by different authors is huge. One-year recurrence rates of AF after ablation off-AAD ranges from 11 to 44% in RCTs and from 9 to 80% in observational studies. The total number of patients studied in RCTs is very small when compared with the hundreds of thousands of patients who have worldwide been treated with catheter ablation so far. From …