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