Pivotal Study Of A Dual Epicardial & Endocardial Procedure (DEEP) Approach

Inclusion Criteria:

1. Symptomatic Persistent Atrial Fibrillation or Longstanding Persistent AtrialFibrillation refractory to a minimum of one Class I or Class III AADs.

Exclusion Criteria:

1. AF >10 years.

2. Refractory hypertension, defined as systolic (>150 mm Hg) or diastolic (> 90 mm Hg)blood pressure that remains uncontrolled despite sustained therapy

3. History of pulmonary hypertension

4. Pulmonary vein stenosis in one or more of the pulmonary veins

5. EP catheter ablation procedure to treat atrial fibrillation within 3 months

6. Undergone prior cardiothoracic surgery, previous thorax trauma which resulted in apneumothorax or hemothorax.

7. Sleep apnea, home oxygen therapy, moderate to severe COPD, (FEV1/FVC < 70%predicted) or patient is considered intolerant to single lung ventilation.

8. NYHA Class IV heart failure.

9. Uncorrected, reversible cause(s) of atrial fibrillation, or is currently beingtreated for arrhythmias other than atrial fibrillation (AF) or atrial flutter.

10. Documented history of previous catheter ablation with perforation, history ofpericarditis, pericardial effusion, or tamponade.

11. Structural heart disease requiring surgical treatment (i.e. valve disease requiringrepair or replacement within 12 months following surgical ablation procedure).

12. CAD requiring intervention (either surgical, i.e. CABG, or catheter).

13. Ejection fraction < 30%

14. Measured left atrial diameter > 5.5 cm

15. Stroke/cerebrovascular accident (CVA) within previous six months, carotid arterystenosis greater than 80%.

16. BMI is >40

17. Thrombus in the left atrium or the left atrial appendage, determined byechocardiography (either at baseline TTE (or equivalent diagnostic test) orintraoperative TEE).

18. Blood dyscrasia or clotting disorder (i.e. Idiopathic Thrombocytopenic Purpura [ITP]or Thrombotic Thrombocytopenic Purpura [TTP]).

19. Contraindication to anticoagulation that in the opinion of the investigator posesundue risk to the patient from participating in the endocardial EP procedure.

20. Documented thromboembolism within the previous six months prior to signing informedconsent.

21. Has the following atrial myxoma, mural thrombus or mural tumor.

22. A condition or congenital anomaly which prevents required surgical or catheteraccess.

23. A co-morbid condition that, in the opinion of the investigator, poses undue risk ofgeneral anesthesia or port access cardiac surgery.

24. Currently abusing drugs or alcohol.

25. Currently or has participated in a clinical study in the last 3 months prior tosigning informed consent.

26. A psychological disorder that could interfere with provision of informed consent,completion of tests, therapy, or follow-up.

27. A condition that, in the opinion of the investigator, may jeopardize the patient'swell-being and/or the soundness of this clinical study.

28. Pre-existing esophageal condition that required (or requires) endoscopic therapy orsurgical treatment.