Posterior Wall Substrate Modification Using Irreversible Electroporation for Paroxysmal Atrial Fibrillation

Exclusion Criteria

• •1. Persistent atrial fibrillation (PeAF) (\> 7 days in duration).
• •2. Atrial arrhythmias secondary to electrolyte imbalance, thyroid disease, or other reversible non-cardiac cause.
• •3. Previous surgical or catheter ablation of AF.
• •4. Previous valve surgery, ventriculotomy, atriotomy, or presence of a mitral mechanical 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 3 months.
• •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 septal defects, Ebstein's anomaly, systemic right ventricle, and transposition of the great arteries.
• •19. Intracardiac or vascular abnormalities that preclude adequate catheter introduction or 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.