Comparison of Pulmonary Vein Ablation With or Without Left Atrial Posterior Wall Ablation for Persistent AF (PIVoTAL)

Inclusion Criteria: * Males and females with an age \>18 years undergoing a first-time catheter ablation of AF; prior ablation of a right atrial cardiac arrhythmia (i.e., typical right atrial flutter) is permitted * All patients must understand the requirements of the study and be willing to comply with the post-study follow-up requirements * Patients must be in AF on the day of the procedure Exclusion Criteria: * Any reversible cause of AF (post-operative, thyroid disorder, etc) * Patients with cerebral ischemic events (stroke or transient ischemic attack), myocardial infarction or unstable angina in the previous 2 months * Patients with any corrected or uncorrected congenital heart disease * Patients with a history of hypertrophic cardiomyopathy * Patients with cardiomyopathy and a left ventricular ejection fraction \<35% * Congestive heart failure, class IV * Women who are known to be pregnant or have had a positive β-Human Chorionic Gonadotropin (β-HCG) test 7 days prior to procedure * Patients whose life expectancy is \<1 year * History of left-sided left atrial ablation (catheter or surgically-based) * Mental impairment precluding the patient from providing informed consent or completing appropriate follow-up