Answer: Thank you for this question. There is a lot of debate on how best to ablate long-standing afib but achieving durable pulmonary vein isolation still remains the cornerstone. I do not think you need to stop amiodarone prior to ablation. Although approaches vary, pulmonary veins are routinely isolated in all approaches. Beyond that, there are diverging practices. My approach would be to do pulmonary vein isolation, then do a 3D voltage map to assess amount of scarring in the atrium to see if there are potential areas that would need ablation, which can be a linear ablation (ablating a small area in a linear fashion) or focal ablation (ablating a particular spot). Following that, I will use escalating doses of a medication called isoproterenol (similar to adrenaline) to induce afib and look for potential triggers and ablate the triggers. Once completed, I will likely continue, along with blood thinners, amiodarone at a small dose (100-200 mg/day) for about 6-9 months to maintain normal sinus rhythm and allow favorable electrical remodeling of upper chambers of the heart. I believe it is important for your heart to get used to normal rhythm after being out of rhythm for 7 years. Also very important in the post-ablation period would be aggressive lifestyle and risk factor modification including weight loss (lose at least 10% of your body weight), testing for and treating sleep apnea if you have that issue and maintaining strict control of blood pressure and, if you have it, diabetes. I do not think LAA occlusion has any clinically significant negative impact on ejection fraction. Wish you the best!