Renal Denervation + PVI vs PVI Alone for Persistent AF

Inclusion Criteria: 1. Age \> 18 years 2. Symptomatic persistent AF eligible for referral for PVI based on current guidelines1 (persistent AF defined as continuation \> 7 days and up to 1 year) 3. No prior history of HTN or HTN controlled on medical therapy (defined as SBP \<140 mm Hg and DBP \<85 mm Hg) 4. Renal vasculature accessible as determined by pre-procedural renal magnetic resonance angiogram 5. Willingness to undergo ILR placement 6. Willingness to comply with post-procedural follow-up requirements and to sign informed consent. Exclusion Criteria: 1. Inability to undergo AF catheter ablation (e.g., presence of a left atrial thrombus, contraindication to all anticoagulation) 2. Prior left atrial ablation for an atrial arrhythmia 3. NYHA class IV congestive heart failure or LVEF \< 25% 4. Paroxysmal AF, or longstanding persistent AF (duration \> 1 year) 5. Coronary revascularization or valve surgery within 3 months 6. Prior valve surgery using a mechanical prosthesis 7. Renal artery anatomy that is ineligible for treatment including: 1. Predicted inability to access renal vasculature 2. Main renal arteries \< 4 mm in diameter or \< 20 mm in length. 3. Hemodynamically or anatomically significant renal artery abnormality or stenosis 4. A history of prior renal artery intervention including balloon angioplasty or stenting that precludes a possibility of ablation treatment 5. Multiple main renal arteries to either kidney 8. An estimated glomerular filtration rate (eGFR) \< 45mL/min/1.73m2, using the MDRD calculation 9. Life expectancy \<1 year for any medical condition