Posterior Wall Substrate Modification Using Irreversible Electroporation for Paroxysmal Atrial Fibrillation

Eligibility Criteria

• 1. Provision of signed and dated informed consent form.
• 2. Stated willingness to comply with all study procedures and availability for the duration of the study.
• 3. Age 21-90 years.
• 4. Symptomatic PAF whether failed AAD or not.
• 5. At least one symptomatic episode of PAF lasting \<7 days, documented on electrocardiogram (ECG), Holter, ZioPatch, ILR, or smartwatch recording in the year prior to enrollment.
• 6. Patients undergoing first time ablation for AF.
• 7. Subject has any commercially available implantable loop recorder (ILR) or agrees to have one implanted prior or during the ablation procedure.
• 1. Persistent atrial fibrillation (PeAF) (\> 7 days in duration).
• 2. Atrial arrhythmias secondary to electrolyte imbalance, thyroid disease, or other reversible non-cardiac cause.
• 3. Previous surgical or catheter ablation of AF.
• 4. Previous valve surgery, ventriculotomy, atriotomy, or presence of a mitral mechanical prosthetic or bioprosthetic valve.
• 5. Left atrium anteroposterior (LA AP) diameter \>55 mm or indexed left atrium (LA) volume \>48 ml/m2.
• 6. Contraindications to oral or systemic anticoagulation.
• 7. Previous thromboembolic event (including ischemic strokes and TIA) within the last 3 months.
• 8. Previous myocardial infarction or percutaneous coronary intervention within the past 2 months.
• 9. Coronary Artery Bypass Grafting (CABG) surgery within the past 6 months (180 days).
• 10. Pregnancy.
• 11. History of PV stenosis.
• 12. History of severe pulmonary hypertension.
• 13. History of diaphragmatic paresis or hemi-paresis.
• 14. History of heart transplantation.
• 15. History of blood clotting or bleeding abnormalities.
• 16. Life expectancy of less than 12 months.
• 17. Presence of intracardiac thrombus.
• 18. Complex congenital heart disease, including tetralogy of Fallot, ventricular septal defects, Ebstein's anomaly, systemic right ventricle, and transposition of the great arteries.
• 19. Intracardiac or vascular abnormalities that preclude adequate catheter introduction or manipulation within the LA.
• 20. Pacing dependent patients.
• 21. Active malignancy or history of treated malignancy within 12 months of enrollment (other than cutaneous basal cell or squamous cell carcinoma).
• 22. Active systemic infection.
• 23. Participation in any other AF-related randomized clinical trial.