Hybrid AF -- A Prospective Registry

Inclusion Criteria: * Documented effectiveness failure of at least one Vaughan-Williams Class III AAD * Persistent AF as defined by the HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation * Absence of significant structural heart disease as demonstrated by a transthoracic echocardiogram (TTE) of all four chambers of the heart, computed tomography (CT) scan or magnetic resonance imaging (MRI) scan within 6 months prior to enrollment * Absence of left atrial thrombus as documented by an imaging study (e.g., TTE, transesophageal echocardiogram (TEE), thoracic CT scan, MRI, or left atrial angiography) within 30 days prior to procedure Exclusion Criteria: * History of longstanding persistent AF for more than 3 years * Documented left atrial size of 60 mm or more * Documented left ventricular ejection fraction (LVEF) less than 40% * History of cerebrovascular disease, including stroke or transient ischemic attack (TIA) within 6 months prior to enrollment * Significant underlying structural heart disease requiring surgical or procedural intervention within the last six months of initial procedure * Known contraindication to anticoagulant therapy, or inability to comply with anticoagulant therapy * Other clinical conditions precluding inclusion (e.g., organ disease, disturbances of hemostasis, etc.) * Pregnancy, planned pregnancy (females of childbearing potential must have a negative pregnancy test prior to enrollment and agree not to become pregnant during the trial) or breastfeeding; * Concomitant procedure planned