Pulmonary Vein Isolation Alone or in Combination With Substrate Modulation After Electric Cardioversion Failure in Patients With Persistent Atrial Fibrillation: a Randomized, Multicentric, and Comparative Study
This study aims at assessing whether electric cardioversion can act as a discriminant factor between patients requiring Pulmonary Vein Isolation (PVI) procedure alone or PVI procedure combined with substrate modulation. All included patients will undergo an electric cardioversion, then: * Patients with electric cardioversion success will be treated as per Standard of Care and according to ESC recommendations (2020). A prospective registry will be implemented for these patients. * Patients with electric cardioversion failure will be randomized in the study between 2 ablative procedures: * PVI procedure alone * PVI procedure combined with substrate modulation
⁃ Criteria to be validated for patients included before performing electric cardioversion:
⁃ 1\) 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.