Safety and Efficacy of Pulmonary Vein Isolation Using Pulsed-field Ablation (PFA) Combined with Either PFA-based Left Atrial Posterior Wall Isolation or Vein of Marshall Ethanol Ablation in Patients with Persistent Atrial Fibrillation

Inclusion Criteria: * Symptomatic persistent AF; 1st or redo ablation with PVI-only in the earlier procedure * Willing to provide informed consent * Age: 18-85 years Exclusion Criteria: * • Previous PWI or VoM ablation procedure * Left ventricular ejection fraction \<40% * Left atrial thrombus * Myocardial infarction within last 60 days * Cardiac surgery in the last 6 months * Advanced renal failure * Life expectancy \<1 year * Pregnant women * Unable or unwilling to provide informed consent