 Ablation of persistentpermanent Atrial Fibrillation AF remains a challenge. There are several strategies to improve the outcomes of persistentpermanent AF ablation. At the Cleveland Clinic one of the commonly used strategies is Direct Current Cardioversion DCC. Depending on physician preference, patients may be ablated in atrial fibrillation then Direct current cardioverted; or Direct current cardioverted and ablated in sinus rhythm. Neither approach has been shown to be superior. As both approaches are currently being performed based on physician preference, the investigators propose to study and compare both approaches in a randomized fashion for evidence based practice. 