During the past decade, a large number of studies have been published that have examined the important issue of the long-term efficacy of AF ablation. Prior to this time, most clinical studies presented data from short-term follow-ups, often less than 12 months in duration. The first of these studies was published 5 years ago and described the long-term outcomes of a series of 264 patients who were AF-free and off AAD therapy at the 12-month point following an initial ablation procedure.284 During a mean follow-up of 28 ± 12 months, AF recurred in 23 patients (8.7%). The actuarial recurrence rate of AF at 5 years was 25.5%. Similar findings have been reported in each of the subsequent trials.266,267,268,1022,1086,1087 The predictors of late recurrence most commonly identified include persistent AF as well as comorbid conditions. Despite the low single-procedure, long-term success rate reported in virtually all of these clinical trials, they also reveal that with the use of repeat AF ablation procedures and/or AAD therapy, much higher rates of freedom from recurrent AF as well as concomitant reductions in AF burden can be achieved.