A total of 549 patients with persAF underwent CA using the stepwise approach at our institution in 2007 to 2009. Of these, 493 © 2015 American Heart Association, Inc. Original Article Circ Arrhythm ElectrophysiolBackground-In the meantime, catheter ablation is widely used for the treatment of persistent atrial fibrillation (AF). There is a paucity of data about long-term outcomes. This study evaluates (1) 5-year single and multiple procedure success and (2) prognostic factors for arrhythmia recurrences after catheter ablation of persistent AF using the stepwise approach aiming at AF termination. Methods and Results-A total of 549 patients with persistent AF underwent de novo catheter ablation using the stepwise approach (2007)(2008)(2009)