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Pulmonary vein antral isolation (PVAI) is established as the cornerstone of AF ablation strategies. The landmark STAR AF II study demonstrated a lack of incremental benefit with adjunctive linear and complex fractionated electrogram ablation beyond PVAI. Randomized studies thus far have failed to consistently show favorable outcomes from other trigger\/substrate\u2010based ablation approaches over PVAI alone. In this issue of the journal, we pose an interesting clinical scenario\u2014of a middle\u2010aged female who presents with recurrent persistent AF but was found to have enduring PVAI on repeat electrophysiologic study. Which approach should be undertaken next? In this review article, we aim to provide an overview of ablation strategies beyond PVAI. Finally in light of scant randomized data to guide decision making we have approached leading experts in the field to provide their approach to this scenario.<\/jats:p>","DOI":"10.1111\/jce.14298","type":"journal-article","created":{"date-parts":[[2019,11,28]],"date-time":"2019-11-28T13:45:55Z","timestamp":1574948755000},"page":"1857-1860","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Persistent atrial fibrillation in the setting of pulmonary vein isolation\u2014Where to next?"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5369-5844","authenticated-orcid":false,"given":"Peter M.","family":"Kistler","sequence":"first","affiliation":[{"name":"Department of Cardiology Alfred Hospital  Melbourne Victoria Australia"},{"name":"Baker Heart and Diabetes Institute  Melbourne Victoria Australia"},{"name":"University of Melbourne  Melbourne Victoria Australia"},{"name":"Monash 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