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In persistent atrial fibrillation (AF), there is no generally accepted technique to improve outcomes of AF ablation, though approaches to ablation beyond pulmonary vein isolation (PVI) continue to be explored. Data suggest that the greater the scar burden (i.e., fibrosis) in the left atrium, the less likely that ablation will be successful, leading to the hypothesis that homogenization of the scar may decrease recurrence. In the Efficacy of Delayed Enhancement-MRI-Guided Fibrosis Ablation vs. Conventional Catheter Ablation of Atrial Fibrillation (DECAAF II) trial, 843 patients with persistent AF undergoing ablation from 2016 to 2020 were randomized to PVI alone or PVI and homogenization of the fibrosis. MRIs were performed in all patients t…