Inclusion criteria |
Age ≥ 18 years |
Long-standing persistent AF (> 12 months’ duration) |
EHRA symptom score > 2 (see Additional file 1) |
Left ventricular ejection fraction ≥ 40% |
Suitable for either ablation procedure |
Exclusion criteria |
Valvular heart disease with severity greater than mild |
Contraindication to anticoagulation |
Thrombus in the left atrium despite anticoagulation in therapeutic range |
Cerebrovascular accident within the previous 6 months |
Previous thoracic or cardiac surgery (including surgical interventions for AF) |
Prior left atrial catheter ablation for AF |
Unable to provide informed written consent |
Active malignancy, another severe concomitant condition or presence of implanted cardiac devices that would preclude patient undergoing study-specific procedures |
Pregnant or breastfeeding, or women of childbearing age not using a reliable contraceptive method |