PVI Alone Versus PVI Plus PWI and SVCI With PFA

Exclusion Criteria

• •Any prior atrial endocardial or epicardial ablation procedure, other than cavotricuspid isthmus ablation or supraventricular tachycardia
• •Stroke or transient ischemic attack within the previous six months
• •Gastrointestinal bleeding within the previous three months
• •Implanted pacemaker or defibrillator
• •Longstanding persistent AF (\> 3 years)
• •LA volume \>80ml/m2
• •Atrial septal occlusion device
• •Current left atrial thrombus
• •Left atrial appendage occlusion or closure device \< 6 mos or with leak or prior DRT
• •Mitral or Tricuspid valve clip or mechanical replacement or clip
• •Hypertrophic cardiomyopathy
• •Contraindication to femoral vascular access
• •Congenital heart disease with residual anatomic abnormality
• •Contraindication to, or unwillingness to use, systemic anticoagulation
• •Pregnancy
• •Left ventricular ejection fraction \<30%
• •Baseline creatinine \>2.0 mg/dL
• •Predicted life expectancy less than one year
• •Refusal to receive ICM implant or allergy to ICM