Clinical Research Directory

Inclusion Criteria: * Symptomatic patients with persistent AF and indication for repeat ablation * procedure. * Patients with recurrent persistent AF (with a duration \<3 year, at least one episode longer than 7 days during the last 6 months and have been electrically cardioverted at least once during the last 12 months) after previous catheter ablation. * Patients with up to two previous catheter ablations for AF are included if the procedures only involved PVI. Previous PVI procedure(s) with both cryoablation and radiofrequency ablation are accepted. * Patients have taken at least one antiarrhythmic drug. * Patients are willing to participate in the study and sign the patient information form. * Age: 18-80 years old. * Patients must be on continuous anticoagulation with warfarin (INR 2-3) or direct oral anticoagulant for \>4 weeks prior to the ablation. Exclusion Criteria: * Patients with \>2 ablation procedures in the LA for AF or atrial flutter * Previous ablation procedures for AF involving ablation strategies beyond PVI * Duration of persistent AF \>3 years * Presence of atrial flutter or atrial tachycardia * Presence of an intracavitary thrombus * Uncontrolled heart failure * Severe valvular disease * LA diameter \> 60 mm * Structural heart disease involving more than moderate valvular stenosis and/or * Insufficiencies * Rheumatic heart disease * Cardiac surgery for valvopathy or for congenital heart disease * Patients with contraindications to systemic anticoagulation * Severe renal dysfunction * Patients who are or may potentially be pregnant. * Patient not able to be followed up.