Extended Ablation Versus Pulmonary Vein Isolation to Treat Persistent Atrial Fibrillation

The aim is to determine the effect of extended ablation (pre-specified linear PF/RF lesion set) in addition to PVI in symptomatic persistent AF patients on AF/AT/AFL recurrence. The study is designed as multicenter, randomized trial. Eligible patients are patients with persistent AF (but not long-standing persistent AF) planned for a first-ever AF ablation procedure. Patients will be randomly assigned 1:1 either to: i) PVI-only, or ii) PVI-plus arms. Patients in both groups will undergo catheter ablation using an ablation system capable of performing PF and RF ablation (Sphere-9, Affera, Medtronic). Patients randomized to the PVI-only arm will undergo only PVI. Patients randomized to the PVI-plus arm will undergo PVI plus linear lesions (roof, bottom line, lateral or anterior MI line, and septal line in the LA; intercaval line and cavotricuspid line in the RA). The primary endpoint will be freedom from recurrent AF/AT/AFL, assessed as time-to-first recurrence in the period of 12 months after randomization (post 2-month blanking period). Secondary clinical endpoints will be 1) 1) AF/AT/AFL burden during the first 12 months after randomization, 2) 2) Quality of life according to the AFEQT questionnaire score at 12 months, 3) 3) AF/AFL/AT-related outcomes (hospitalization or emergency visits), 4) MACE defined as cardiovascular death, stroke, myocardial infarction, or hospitalization for heart failuree, 5) A composite of pre-specified, procedure-related SAE within 7 days after the procedure, including clinically relevant delayed SAEs adjudicated as related to the index ablation procedure. Secondary endpoints will be evaluated throughout the entire (minimum 12-month) follow-up period.