AF Ablation With or Without ROX Coupler Study

Inclusion Criteria: * Symptomatic paroxysmal AF suitable for AF ablation. * Office Systolic blood pressure ≥ 140 mmHg based on an average of 3 blood pressure readings * Ambulatory Blood Pressure Monitoring (ABPM) daytime average systolic blood pressure (SBP) ≥ 135 mmHg; * Resistant Hypertension: Patients with established hypertension (diagnosed ≥ 12 months prior to baseline) and is on a guideline based drug regimen at a stable and a fully tolerated dose, consisting of ≥3 hypertensive medications (including 1 diuretic), or * Uncontrolled Hypertension: Patient has drug intolerances to antihypertensive medications and is unable to take a guideline based drug regimen * VO2 peak \> 15mls/Kg/min on Cardiopulmonary exercise testing (CPX) * Peak RER \> 1.0 on Cardiopulmonary exercise testing * Age over 18 years old. * Informed consent to participate in this study. Exclusion Criteria: * Secondary hypertension amenable to conventional therapy * Left ventricular systolic dysfunction with EF \< 50% * E/E' \> 15 on transthoracic echocardiography * Uncontrolled diabetes. * Body Mass Index \> 40 kg/m2 * Contraindicated for treatment with an arteriovenous anastomosis or interventional vascular procedure * Severe chronic kidney disease as indicated by estimated glomerular filtration rate \< 30 mL/min/1.73m2 using the MDRD calculation * Renal denervation within the last 6 months * Significant peripheral arterial and/or venous disease in the lower limbs (including unprovoked deep vein thrombosis, significant lower extremity edema and/or venous insufficiency) * Current diagnosis of unstable cardiac disease requiring intervention,or significant history of serious cardiac comorbidity that may affect patient safety or study outcomes * Current diagnosis of severe cerebrovascular disease or stroke within the past year * Female patient who is pregnant, breastfeeding or planning to become pregnant; females of child-bearing potential must have a negative urine pregnancy test prior to treatment * Any known, unresolved history of drug use or alcohol dependency, lacks the ability to comprehend or follow instructions, or would be unlikely or unable to comply with study follow-up requirements * Scheduled or planned surgery in the next 6 months that may affect patient safety or study outcomes * Concurrent enrollment in another clinical trial without prior approval of ROX Medical, Inc. * Any serious medical condition that may adversely affect the patient's safety, limit the subject's ability to participate in the study, comply with follow-up requirements or impact the scientific integrity of the study * Intolerant or allergic to all anti-thrombolytic medications including aspirin * Pulmonary arterial hypertension (PAH) defined as mean pulmonary artery pressure (mPAP) \>30 mmHg as measured by right heart catheterization * Pulmonary capillary wedge pressure (PCWP) \> 15mmHg as measured by right heart catheterization * Pre-existing ILRs or permanent pacemakers that do not allow for continuous monitoring for AF occurrence. * Participation in a conflicting study. * Potential participants who are mentally incapacitated and cannot consent or comply with follow-up. * Pregnancy. * Other cardiac rhythm disorders. * Severe aortic and mitral valve disease. * Previous ROX coupler implantation.