Pulmonary Vein Isolation Alone or in Combination With Substrate Modulation After Electric Cardioversion Failure

Inclusion criteria: Criteria to be validated for patients included before performing electric cardioversion:

1. Persistent AF (continuous for at least 7 days without interruption according toinformation transmitted by the cardiologist and the patient), symptomatic and resistant toat leat one anti-arrhythmic drug treatment including amiodarone; Criteria to be validated for patients included after performing electric cardioversion :

1. Patient treated by electric cardioversion for persistent AF, symptomatic and resistantto anti-arrhythmic treatment including amiodarone and whom ablative procedure isplanned in the following 4-6 weeks after electric cardioversion Criteria to be validated for all patients included:
2. Life expectancy > 5 years;
3. Female or male between 18 and 80 years of age at the electric cardioversion time
4. Affiliation to a health insurance system;
5. Patient informed of the study and having signed informed consent Criteria to be validated prior to randomization on the day of ablation (these patientsmay be randomized):
6. Patient with failed electric cardioversion i.e. in AF, confirmed by ECG.

Exclusion criteria: Criteria to be validated before or after performing electric cardioversion (the studycannot be proposed to patients corresponding to these criteria):

1. Current hyperthyroidism;
2. Pregnant or breastfeeding woman;
3. Patient with a Body Mass Index (BMI) greater than 35;
4. Patient with severe Chronic Obstructive Pulmonary Disease (COPD);
5. Patient with hypertrophic heart disease;
6. Patient with a mechanical or biological mitral valve;
7. Contraindications to anticoagulants;
8. Transient Ischemic Attack (TIA) /stroke less than 6 months old;
9. Psychiatric illness affecting follow-up;
10. Left Ventricular Ejection Fraction (LVEF) < 40% ;
11. Uncontrolled ischaemic heart disease (angina, myocardial ischaemia)
12. Patients under legal protection
13. Cardiac surgery on left atrium
14. Inflammatory status in progress (cancer, rheumatoid arthritis, PPRZ, acute or chronicperiodontitis, Crohn's disease, RCUH)
15. Pulmonary embolism or phlebitis less than 6 months old
16. Prior atrial fibrillation ablation
17. Active cancer Criteria to be validated before randomization, on the day of ablation (these patientscannot be randomized):
18. Patient in sinus rhythm 4-6 weeks after electric cardioversion: these patients areincluded in the study registry.
19. Patient with complete absence of sinus rhythm (less than 10 seconds) after 3 electriccardioversion attempts: these patients will discontinue from the study.