Background: This study aimed to explore the clinical results of posterior wall dual-box ablation (PWDB) in individuals with persistent atrial fibrillation (AF) and left atrial enlargement (LAE). Methods: This study retrospectively analyzed 280 patients with atrial fibrillation (AF) categorized into the Posterior Wall Dual-Box Ablation (PWDB) group (n=140) and the Pulmonary Vein Isolation (PVI) group (n=140) who underwent radiofrequency ablation (RFA) in AJK between June 2022 and November 2023. Results: Both the groups exhibited similar baseline characteristics. However, the PWDB group demonstrated significantly shorter operation and ablation times, reduced X-ray exposure, and no AF recurrence during follow-up, in contrast to one recurrence in the PVI group. Adverse events were less frequent in the PWDB group. Conclusion: These findings suggest that PWDB may offer procedural advantages and potentially lower AF recurrence rates than PVI in patients with persistent AF and left atrial enlargement. Further research is necessary to validate these outcomes and assess their long-term implications.