Correlation of the Arrhythmia Mechanism and Substrate to Ablate Persistent Atrial Fibrillation Study

This is a pilot study to assess the usefulness of ECG mapping, and enhanced MRI and PET scan imaging in identifying atrial fibrosis and arrhythmia circuits involved in persistent atrial fibrillation and in guiding an innovative AF catheter ablation strategy. It is hypothesized that identifying these critical arrhythmia circuits and atrial fibrosis with enhanced imaging and performing an individualized innovative AF catheter ablation will result in higher procedural success rates.

Inclusion Criteria: * Age ≥18 years and ≤ 80 years; * Symptomatic persistent AF AND clinically indicated for AF catheter ablation * At least one episode of AF lasting more than 7 days, documented on 12-lead ECG, Holter monitor, 2-week loop monitor or trans-telephonic monitor (TTM) within 12 months of enrollment in the study * Able to provide informed consent. Exclusion Criteria: * History of previous catheter or surgical ablation for AF * Presence of intracardiac thrombus * contraindication to systemic oral anticoagulation therapy * Subjects with reversible causes of AF * Antero-posterior left atrial dimension \> 60 mm on echocardiography * Severe valvular disease (mitral/aortic stenosis or regurgitation); * Subjects that are pregnant or breastfeeding; * Chronic kidney disease and creatinine clearance \