Background: Pulmonary vein isolation (PVI) using cryoballoon ablation (PVI-C) is increasingly performed as a first-line strategy for the treatment of patients with persistent atrial fibrillation (PersAF); however, follow-up data and predictors of procedural success are lacking. Objective: To study the efficacy of PVI-C in patients with PersAF, focusing on predictors of procedural success. Methods: By retrospective review, 148 consecutive patients with PersAF who underwent PVI-C were analyzed.  The impact of several variables on outcome was evaluated in univariate and multivariate analyses and Cox proportional hazards regression models. Results: After a mean follow-up of 19.2±10.9 months, 75 (50.7%) patients remained arrhythmia-free without the need for antiarrhythmic drug therapy.  Patients with a normal left atrial volume index (LAVI) achieved a 71.0% arrhythmia-free survival.  LAVI was the most powerful predictor of procedural success. Conclusion: Arrhythmia-free survival after PVI-C in select patients with PersAF are promising. Moreover, LAVI is a valuable measurement to help guide ablation strategy and predict outcome when using cryoballoon ablation.