Optimized Ablation of the Posterior Wall in Persistent Atrial Fibrillation

Optimized Ablation of the Posterior Wall in Persistent Atrial Fibrillation

The design of this study is an intervention, randomized, controlled study and contains three randomized groups：（1）PVI group；（2）PVI+PWI group;（3）PVI+PWI+EGM group.

Inclusion Criteria:

1. Age ≥18 years
2. First-time ablation for persistent atrial fibrillation (PsAF)
3. Persistent AF definition: Sustained episodes lasting ≥7 days but ≤3 years (including episodes requiring pharmacologic or electrical cardioversion after ≥7 days)
4. Symptomatic AF with intolerance to at least one antiarrhythmic drug (AAD)
5. Documented PsAF episode: At least one recorded PsAF episode within the last 2 years prior to enrollment, confirmed by: ECG,Holter monitorin, Loop recorder, Telemetry, Transtelephonic monitoring (TTM),Implantable device
6. Ability and willingness to provide written informed consent
7. Compliance with all study follow-up requirements

Exclusion Criteria:

1. Paroxysmal AF: Episodes lasting <7 days (or requiring pharmacologic/electrical cardioversion <7 days)
2. Long-standing persistent AF: Continuous AF duration >3 years
3. No prior attempt/pursuit of cardioversion or sinus rhythm maintenance
4. Contraindications to systemic anticoagulation
5. Pregnancy
6. Advanced renal or hepatic failure
7. Severe valvular heart disease or cyanotic congenital heart disease
8. Hypertrophic cardiomyopathy (HCM)