Inclusion Criteria:  Persistent atrial fibrillation The patient has signed the informed consent form No LAA previous ablation procedure No valvular disease LVEF ≥ 35% prior to recruitment Age ≥ 18 years  Exclusion Criteria:  LVEF < 35 % Hyperthyroidism or hypothyroidism Mental or physical illness incapacitation Planned cardiac procedure Non-controlled hypertension Terminal renal failure or dialysis Class IV of the NYHA Age ≥ 75 years Life expectancy < 2 years Atrioventricular block Pregnancy