Comparative Effectiveness of Different Techniques for Repeat Ablation of Atrial Fibrillation

Inclusion Criteria * Age ≥ 18 years on date of consent * One prior PVI ablation procedure \> 3 months prior for persistent AF * Recurrent paroxysmal or persistent symptomatic AF confirmed on ECG despite prior PVI * Eligible for repeat ablation procedure * Willingness to comply with all post-procedural follow-up requirements and to sign informed consent Exclusion Criteria * Inability to undergo AF catheter ablation (e.g., presence of a left atrial thrombus) * Prior ablation that included non-PVI LA ablation, or more than one prior PVI ablation procedure for persistent AF * Prior surgical ablation for AF * Contraindication to systematic anticoagulation * LA diameter on echocardiogram \> 6.0 cms * LV ejection fraction \< 35% * NYHA class III-IV congestive heart failure * Acute coronary syndrome or coronary artery bypass surgery or percutaneous coronary intervention (balloon and/or stent angioplasty) within 3 calendar months prior to consent date * Enzyme-positive myocardial infarction within the past 3 calendar months prior to consent * Severe aortic or mitral valvular heart disease eligible for percutaneous or surgical repair/replacement procedures * Prior valve replacement with mechanical prosthesis * Angiographic evidence of coronary disease that requires coronary revascularization and with likelihood of undergoing a CABG or PCI in the next 3 calendar months following consent date * Stroke within 3 calendar months prior to consent date * Any medical condition likely to lim…