Original Article

Catheter ablation (CA) is an established treatment option for patients with drug refractory paroxysmal atrial fibrillation (AF) supported by international guidelines.1,2 However, CA for persistent AF (PeAF) is more controver-sial. In the United States, CA for PeAF is not approved by the Food and Drug Administration, and its use for this indi-cation is still considered off-label.3 Within Europe, funding for PeAF ablation recently came under threat from at least 1 National Health Service regional commissioning group in the United Kingdom and by the Healthcare Knowledge Center in Belgium.4 Despite these restrictions, CA is still widely performed for PeAF and is a class 2A recommen-dation for patients who remain symptomatic despite anti-arrhythmic drugs (AADs).1,2 The most recent survey of worldwide practice showed that 86 % of centers performing AF ablations undertook procedures on patients with PeAF and 47 % on patients with longstanding PeAF. Overall, a little over 40 % of patients undergoing ablation were classi-fied as having PeAF or longstanding PeAF.5 The median suc-cess rates in this registry study were 75 % for PeAF and 71% for longstanding PeAF (compared with 84 % for paroxysmal AF). However, there is a notable dearth of supporting pro-spective trial data. In addition, recent development of rotor-guided ablation has brought into question the importance o