SPHERE Per-AF Post-Approval Study

Inclusion Criteria: 1. A diagnosis of recurrent symptomatic persistent AF (continuous AF sustained longer than 7 days but less than 12 months) 2. Refractory (i.e. not effective, not tolerated, or not desired) to at least one Class I or III antiarrhythmic drug (AAD) 3. Patient is ≥ 18 years of age 4. Planned de novo pulmonary vein isolation procedure using commercially available Sphere-9™ Catheter and Affera Ablation System 5. Patient is willing and able to comply with study requirements and give informed consent Exclusion Criteria: 1. Long-standing persistent AF (continuous AF sustained \>12 months) 2. Prior left atrial catheter or surgical ablation 3. Life expectancy \<36 months 4. Presence of a permanent pacemaker, biventricular pacemaker, loop recorder/insertable cardiac monitor (ICM), or any type of implantable cardiac defibrillator (with or without biventricular pacing function) 5. Current or anticipated participation in any other clinical trial of a drug, device or biologic during the duration of this study not pre-approved by Medtronic