Dual Epicardial Endocardial Persistent Atrial Fibrillation(AF) Study (Staged DEEP)

The purpose of this clinical investigation is to evaluate how safe a less invasive cardiac
surgery using the AtriCure Bipolar System in conjunction with a catheter ablation procedure
performed approximately 1-10 days after, in treating atrial fibrillation, and how effective
is this staged procedure. The AtriCure Bipolar System will be used to perform the less
invasive cardiac surgery and a standard electrophysiology catheter, currently available,
will be used to perform the catheter ablation procedure. This surgical procedure is
considered less invasive because it is done through tiny surgical punctures on the sides of
the chest near the ribs instead of one large surgical incision of the breast bone to
completely open the chest and access the heart, and it also avoids the need for the
heart-lung bypass machine.

Inclusion Criteria:

- Age > 18 year

- Patients with symptomatic persistent or longstanding persistent AF refractory to a
minimum of one Class I or III AAD(s).

- Patients with failed catheter ablation attempts are eligible if the patients are
symptomatic with persistent or longstanding persistent AF. (catheter ablation
procedure must be more than 3 months prior to index procedure)

- Life expectancy of at least two years

- Patient will and able to provide informed consent

- Patient is willing and able to attend the scheduled follow-up visits

Exclusion Criteria:

- Prior Cardiothoracic Surgery

- Patient has NYHA Class IV heart failure

- Evidence of underlying structural heart disease requiring surgical treatment

- Surgical procedure within the 30 days prior to the index procedure

- Ejection fraction < 30%

- Measured left atrial diameter > 6.0 cm

- Renal Failure

- Stroke within previous 6 months

- Known carotid artery stenosis greater than 80%

- Evidence of significant active infection or endocarditis

- Pregnant woman or women desiring to become pregnant in the next 24 months

- Presence of thrombus in the left atrium determined by echocardiography

- History of blood dyscrasia

- Contraindication to anticoagulation, based on Investigator's opinion

- Mural thrombus or tumor

- Moderate to Severe COPD