Is pulmonary vein isolation enough for persistent atrial fibrillation?

Pulmonary vein isolation (PVI) is a well-established treatment for atrial fibrillation (AF); however, studies report suboptimal outcomes in persistent AF. Adjuvant ablation targeting the substrate outside the pulmonary veins has been proposed to improve the success rates of the procedure. In this review, we summarize the current evidence regarding additional ablation over PVI in persistent AF. We describe the different approaches for adjuvant ablation, outcomes, and future perspectives.