Cryoballoon Ablation for Early Persistent Atrial Fibrillation (Cryo4 Persistent AF)

Inclusion Criteria: * Patients with documented symptomatic persistent AF refractory or intolerant to at least 1 class I or III antiarrhythmic medication. Persistent AF defined as: * Episode lasting longer than 7 days, but less than 1 year documented by consecutive ECG recordings of 100% AF greater than 7 days apart OR * Episode requiring electrical or pharmacological cardioversion after 48 hours of AF documented by continuous recording * Date of first diagnosis of persistent AF within the last 12 months preceding the consent date * Age between 18 and 75 years * Willing to comply with study requirements and give informed consent (defined as legally effective, documented confirmation of a subject's (or their legally authorized representative or guardian) voluntary agreement to participate in a particular clinical study) to participate in this clinical study Exclusion Criteria: * Long-standing persistent AF (has lasted for ≥1 year) * Current diagnosis of paroxysmal AF * Anteroposterior LA diameter \> 5.0 cm by TTE * Current intracardiac thrombus * Presence of one or more pulmonary vein stents * Presence of any pre-existing pulmonary vein stenosis * Primary pulmonary hypertension * NYHA class IV congestive heart failure and/or documented left ventricular ejection fraction (LVEF) \< 40% measure by acceptable cardiac testing (e.g. TTE) * Hypertrophic cardiomyopathy * Previous LA ablation or surgery * Unstable angina * Presence of any cardiac valve prosthesis * Thrombocytosis, thrombocytopenia * Any condition contraindicating chronic anticoagulation * Any cardiac surgery, myocardial infarction, PCI / PTCA or coronary artery stenting which occurred during the 3 month interval preceding the consent date * Any cerebral ischemic event (strokes or TIAs) which occurred during the 6 month interval preceding the consent date * Cryoglobulinemia * Presence or likely implant of a permanent pacemaker, biventricular pacemaker, loop recorder, or any type of implantable cardiac defibrillator (with or without biventricular pacing function) within 12 months * Uncontrolled hyperthyroidism * Any woman known to be pregnant or breastfeeding * Active systemic infection * Subject is employed by Medtronic or by the department of any of the investigators or is a close relative of any of the investigators * Life expectancy ≤ 1 year * Currently enrolled or plans to participate in a potentially confounding drug or device trial during the course of this study. Co-enrollment in concurrent studies is allowed when documented pre-approval is obtained from the Medtronic study manager * Exclusion criteria as per local laws (for France, this includes, but is not limited to: incompetent adults or patients that are not affiliated to the French social security system)