CPVI With Modified Linear Ablation Versus CPVI in Patients With Long-standing Persistent Atrial Fibrillation (SINUS)

Inclusion Criteria:

1.

1. Patients with symptomatic LSPAF refractory to at least one antiarrhythmic drug;LSPAF will be defined as a sustained AF episode lasting ≥ 1 year;

2. AF duration 1-3 years;

3. Age 18 - 75 years;

4. Left atrial diameter (LAD) 43-55 mm on long axis parasternal view;

5. AF recorded within 3 years of enrollment;

6. Patient willing and able to comply with protocol and sign informed consent

Exclusion Criteria:

1. Paroxysmal atrial fibrillation;

2. Persistent AF lasting < 1 year or >3 years;

3. Left atrial thrombosis;

4. Patients with a history of catheter ablation for AF;

5. Patients with severe structural heart disease (severe valvular heart disease,hypertrophic cardiomyopathy, dilated cardiomyopathy, etc.);

6. LAD > 55mm on long axis parasternal view;

7. Left ventricular ejection fraction (LVEF) < 40%;

8. Patients with contraindications to low molecular weight heparin, warfarin or noveloral anticoagulants;

9. One-stop procedure for AF ablation and left atrial appendage occlusion;

10. Alcohol allergy or contrast agent allergy;

11. Patients taking cephalosporin antibiotics within 72 hours prior to ablation;

12. Pulmonary artery systolic pressure > 50mmHg;

13. Patients with unstable angina pectoris;

14. Patients who had undergone percutaneous coronary intervention (PCI) within 3 months;

15. Patients who had undergone surgery within 6 months;

16. Patients ready to receive heart transplantation;

17. Patients with a history of thromboembolism within 6 months;

18. Patients with diagnosed atrial myxoma;

19. Patients with severe respiratory diseases;

20. Patients with infectious diseases in active phase;

21. Patients with poorly controlled systemic immune diseases;

22. Patients with uncured malignant hematological diseases;

23. Patients with uncured malignant solid tumors;

24. Patients with untreated hypothyroidism or hyperthyroidism;

25. Patients with severe liver dysfunction (elevation of transaminases [ALT or AST] >3times the upper limit of normal range);

26. Patients with end-stage renal failure requiring dialysis;

27. Patients with other serious arrhythmias, such as ventricular tachycardia withhemodynamic instability;

28. Pregnant and lactating women;

29. Patients with psychiatric ailments;

30. BMI < 18.5 or ≥ 30kg/m2;

31. Life expectancy < 2 years;

32. Patients unwilling or unable to give informed consent;

33. Patients unwilling or unable to cooperate to complete follow-up.