A Randomized Sham-controlled Study of Pulmonary Vein Isolation in Symptomatic Atrial Fibrillation

Inclusion Criteria: * Age greater than or equal to 18 years * Symptomatic paroxysmal or persistent atrial fibrillation despite at least one antiarrhythmic drug (AAD Type I or III, β-blocker or AAD intolerance). * Referred for catheter ablation Exclusion Criteria: * Long term persistent AF (continuous episode lasting more than 1) * Prior left atrium catheter or surgical atrial fibrillation ablation * Patients with other arrhythmias requiring ablative therapy * Left atrium (LA) ≥5.5 cm * Any cardiac surgery or percutaneous coronary intervention (PCI) within three months prior to enrolment. * Awaiting cardiac surgery or PCI * Myocardial infarction within three months prior to enrolment. * Stroke or transient ischemic attack (TIA) within three months prior to enrolment * Unstable angina * Any significant congenital heart defect corrected or not (including atrial septal defects or PV abnormalities) but not including patent foramen ovale. * Any condition contraindicating chronic anticoagulation * Any untreated or uncontrolled hyperthyroidism or hypothyroidism * Severe chronic kidney disease (stage V, requiring or almost requiring dialysis, glomerular filtration rate (GFR) \< 15 ml / min) * Patients with metallic prosthetic valves * Pregnant or breastfeeding women * Medical conditions limiting expected survival to \<1 year * History of claustrophobia or panic attacks * Left ventricular ejection fraction (LVEF) less than 35%