Background: Ablation in patients with persistent atrial fibrillation is associated with an increased risk of recurrence. One of the reasons for this is extended left atrial scarring, which can be identified as low-voltage areas (LVA) during left atrial mapping. To increase the success of ablation, these areas should be adequately identified to estimate the success of ablation based on a cut-off value. Therefore, this study aimed to show the relationship between left atrial voltage and the risk of recurrence for patients after ablation of persistent atrial fibrillation. Methods: In this prospective study, 70 patients with persistent AF underwent ablation using a modified stepwise approach. We compared two groups according to the Utah fibrosis criteria: the mild group, with left atrial LVA smaller than 20%, and the severe group, with left atrial LVA of 20% or larger. Both groups were compared based on freedom from any atrial arrhythmia recurrence (>30 secondswith repeated 7-day Holterelectrocardiogram) at 12 months and the use of antiarrhythmic drugs. Results: All patients with atrial fibrillation converted to sinus rhythm by ablation (n=7) had a scar area smaller than 20%. All patients with LVA of 20% or larger were externally cardioverted to to sinus rhythm at the end of the procedure. LVA of 20% or larger tended to show increased recurrence rates after ablation (p= 0.058), significantly shorter periods before recurrence (p=0.041), and a trend toward even shorter periods before recurrence after repeat ablation (p=0.059). Conclusion: The extent of left atrial LVA influences the acute and long-term outcomes of persistent atrial fibrillation ablation. Patients with LVA smaller than 20% could benefit from a stepwise approach.