Posterior Wall Substrate Modification Using Irreversible Electroporation for Paroxysmal Atrial Fibrillation

Inclusion Criteria:

1. Provision of signed and dated informed consent form.

2. Stated willingness to comply with all study procedures and availability for theduration 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 onelectrocardiogram (ECG), Holter, ZioPatch, ILR, or smartwatch recording in the yearprior to enrollment.

6. Patients undergoing first time ablation for AF.

7. Subject has any commercially available implantable loop recorder (ILR) or agrees tohave one implanted prior or during the ablation procedure.

Exclusion Criteria:

1. Persistent atrial fibrillation (PeAF) (> 7 days in duration).

2. Atrial arrhythmias secondary to electrolyte imbalance, thyroid disease, or otherreversible non-cardiac cause.

3. Previous surgical or catheter ablation of AF.

4. Previous valve surgery, ventriculotomy, atriotomy, or presence of a mitralmechanical 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 3months.

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 septaldefects, Ebstein's anomaly, systemic right ventricle, and transposition of the greatarteries.

19. Intracardiac or vascular abnormalities that preclude adequate catheter introductionor 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.