2.1 | Study population
This prospective study registered at the Chinese Clinical Trial Registry (ChiCTR2300068980) was conducted in accordance with the principles outlined in the Helsinki Declaration and approved by the ethics committee of Beijing Anzhen Hospital. Informed written consent was obtained from all participants before enrollment. Patients with drug-refractory PeAF undergoing their initial PFA procedure at Beijing Anzhen Hospital were prospectively enrolled. The study flowchart is depicted in Figure 1. The inclusion and exclusion criteria were as follows. Inclusion criteria: 1) Age over 18 years and less than 80 years; 2) AF duration between 3 months to 3 years; 3) No previous history of AF ablation; 4) Willingness to provide written informed consent and participate in follow-up assessments; 5) Cardiac thrombus excluded by transesophageal echocardiography or intracardiac echocardiography. Exclusion criteria: 1) Previous history of AF ablation; 2) Previous history of left LA surgery; 3) LA diameter > 55mm; 4) Other serious heart disease, or other serious arrhythmias except AF, atrial flutter (AFL) and atrial tachycardia (AT); 5) Contraindications for ablation, such as atrial thrombus, tumor, infection, or other terminal illnesses.; 6) Significant bleeding event, or can not tolerate anticoagulation therapy.