Conclusions
Ablation of persistent atrial fibrillation in atrial fibrillation with ventricular pacing, compared to sinus rhythm with atrial pacing, results in similar catheter stability and lesion quality as assessed by impedance decline and ablation parameters. Given the recent evidence suggesting voltage mapping during atrial fibrillation may provide more accurate assessment of atrial fibrosis, it may be preferable, at least in patients presenting in AF, to ablate during atrial fibrillation with ventricular pacing, and defer cardioversion until after procedure completion.