A relatively new non-PV-based strategy for ablation of AF involves targeting non-PV triggers and reentrant tachycardias that arise from the LAA.541 Over the past 5 years, new information has been published showing promising outcomes using a variety of non-PV-based ablation strategies that target the LAA. These strategies include focal ablation of non-PV triggers arising in the appendage,541 electrical isolation of the LAA,541,542,543,544 and most recently, ligation of the LAA, although this approach is an off-label use of LA tissue ligation.532,533,535,536 LAA isolation has been described using a technique similar to that of PVI: with the circular mapping catheter positioned at the level of the LAA ostium, addressing the earliest LAA activation site (preferably during sinus rhythm). Care should be taken not to ablate inside the LAA (risk of perforation and PN injury). After LAA isolation, patients should be kept on long-term OAC or considered for LAA occlusion. This reflects the results of a recent study that has reported an increased stroke risk following LAA electrical isolation.544 The recently published BELIEF trial randomized 173 patients to start AF ablation or to start standard AF ablation with empirical electrical isolation of the LAA. After an average of 1.3 procedures, the cumulative success at 24 months’ follow-up was 76% in the combined group vs 56% with standard AF ablation.528,529 One approach to address this potential issue is to combine LAA electrical isolation with placement of a Watchman Device.542,543 Recent animal and human studies have also reported the feasibility of this combined strategy.542,543 Currently, a prospective randomized clinical trial is being performed to determine if LAA ligation with the LARIAT device will improve the efficacy of PVI in patients with persistent AF. The outcome of this trial will be required to provide a clear indication for this approach. A survey of the writing group members shows LAA focal ablation, isolation, or ligation as an initial ablation strategy in patients with PAF is used by 2% of the writing group members, and 4% use the above for repeat AF ablation procedures in patients with PAF. For patients with persistent and long-standing persistent AF, LAA focal ablation, isolation, or ligation was used by 9% of the writing group members as an initial ablation strategy in patients with PAF, and was used by 11% of the writing group members for repeat AF ablation procedures in patients with persistent and long-standing persistent AF. There is need for additional well-performed, prospective, multicenter randomized trials in order to determine the safety and efficacy of this approach.