Ablation outcomes in 22 consecutive long-standing persistent atrial fibrillation (LPAF) patients with failed direct current cardioversion (DCCV; group 1) were compared with findings in 22 consecutive LPAF patients who had successful DCCV (control 1) and 22 consecutive patients with paroxysmal atrial fibrillation (AF; control 2). All patients underwent a stepwise progressive ablation protocol (pulmonary vein isolation, ablation of complex fractionated atrial electrogram, and repeat ablation of any induced atrial tachycardias). Over 18-month follow-up, 59 % of group 1 patients remained in sinus rhythm without recurrent AF, compared to 64 % and 77 % in controls 1 and 2, respectively. The procedure time was longer in LPAF with a higher procedure complication risk in these 44 LPAF patients (5 % vs. 0 %) than in patients with paroxysmal AF. Our data suggest that catheter ablation provides a practical treatment option with moderate efficacy for restoring sinus rhythm in LPAF patients after failed DCCV.