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:
• \) Persistent AF (continuous for at least 7 days without interruption according to information transmitted by the cardiologist and the patient), symptomatic and resistant to at leat one anti-arrhythmic drug treatment including amiodarone;
• Criteria to be validated for patients included after performing electric cardioversion :
• Patient treated by electric cardioversion for persistent AF, symptomatic and resistant to anti-arrhythmic treatment including amiodarone and whom ablative procedure is planned in the following 4-6 weeks after electric cardioversion
• Criteria to be validated for all patients included:
• Life expectancy \> 5 years;
• Female or male between 18 and 80 years of age at the electric cardioversion time
• Affiliation to a health insurance system;
• Patient informed of the study and having signed informed consent
• Criteria to be validated prior to randomization on the day of ablation (these patients may be randomized):
• 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 study cannot be proposed to patients corresponding to these criteria):
• Current hyperthyroidism;
• Pregnant or breastfeeding woman;
• Patient with a Body Mass Index (BMI) greater than 35;
• Patient with severe Chronic Obstructive Pulmonary Disease (COPD);
• Patient with hypertrophic heart disease;
• Patient with a mechanical or biological mitral valve;
• Contraindications to anticoagulants;
• Transient Ischemic Attack (TIA) /stroke less than 6 months old;
• Psychiatric illness affecting follow-up;
• Left Ventricular Ejection Fraction (LVEF) \< 40% ;
• Uncontrolled ischaemic heart disease (angina, myocardial ischaemia)
• Patients under legal protection
• Cardiac surgery on left atrium
• Inflammatory status in progress (cancer, rheumatoid arthritis, PPRZ, acute or chronic periodontitis, Crohn's disease, RCUH)
• Pulmonary embolism or phlebitis less than 6 months old
• Prior atrial fibrillation ablation
• Active cancer
• Criteria to be validated before randomization, on the day of ablation (these patients cannot be randomized):
• Patient in sinus rhythm 4-6 weeks after electric cardioversion: these patients are included in the study registry.
• Patient with complete absence of sinus rhythm (less than 10 seconds) after 3 electric cardioversion attempts: these patients will discontinue from the study.