VOLT-AF IDE Clinical Study

Inclusion Criteria:

1. Documented symptomatic PAF or PersAF. Documentation requirements are as follows: Paroxysmal:

• Physician's note indicating recurrent self-terminating AF with ≥ 2 episodes ofPAF within the 6 months prior to enrollment AND

• One electrocardiographically documented PAF episode within 12 months prior toenrollment. Persistent: Continuous AF sustained beyond 7 days and less than 1 year that isdocumented by

• Physician's note, AND either

• 24-hour Holter within 180 days prior to enrollment, showing continuous AF, OR

• Two electrocardiograms (from any form of rhythm monitoring) showing continuousAF:

• That are taken at least 7 days apart but less than 12 months apart

• If electrograms are more than 12 months apart, there must be one or moreSinus Rhythm recordings in between or within 12 months prior toconsent/enrollment

• The most recent electrocardiogram must be within 180 days of enrollment. NOTE: Documented evidence of the AF episode must either be continuous AF on a 12-lead ECG or include at least 30 seconds of AF from another ECG device.

2. Plans to undergo a PVI catheter ablation procedure due to symptomatic PAF or PersAFand is refractory, intolerant, or contraindicated to at least one Class I-IV AADmedication

3. At least 18 years of age

4. Able and willing to comply with all trial requirements including pre-procedure,post- procedure, and follow-up testing and requirements

5. Informed of the nature of the trial, agreed to its provisions, and has providedwritten informed consent as approved by the Institutional Review Board/EthicsCommittee (IRB/EC) of the respective clinical trial site.

Exclusion Criteria:

1. Previously diagnosed long-standing persistent atrial fibrillation (Continuous AFgreater than 1 year in duration)

2. Arrhythmia due to reversible causes including thyroid disorders, acute alcoholintoxication, electrolyte imbalance, severe untreated sleep apnea, and other majorsurgical procedures in the preceding 90 days

3. Patient known to require ablation beyond PVI at the time of consent.

4. Known presence of cardiac thrombus

5. Left atrial diameter ≥ 5.5 cm (anteroposterior diameter) within 180 days of indexprocedure.

6. Left ventricular ejection fraction < 35% as assessed with echocardiography within 180 days of index procedure

7. New York Heart Association (NYHA) class III or IV heart failure

8. Body mass index > 40 kg/m2

9. Pregnant, nursing, or planning to become pregnant during the clinical investigationfollow-up period

10. Patients who have had a ventriculotomy or atriotomy within the preceding 30 days ofprocedure,

11. Myocardial infarction (MI), acute coronary syndrome, percutaneous coronaryintervention (PCI), or valve or coronary bypass grafting surgery within preceding 90days

12. Unstable angina

13. Stroke or TIA (transient ischemic attack) within the last 90 days

14. Heart disease in which corrective surgery is anticipated within 180 days afterprocedure

15. History of blood clotting or bleeding abnormalities including thrombocytosis,thrombocytopenia, bleeding diathesis, or suspected anti-coagulant state

16. Contraindication to long term anti-thromboembolic therapy

17. Patient unable to receive heparin or an acceptable alternative to achieve adequateanticoagulation

18. Known sensitivity to contrast media (if needed during the procedure) that cannot becontrolled with pre-medication

19. Previous left atrial surgical or left atrial catheter ablation procedure (includingLAA closure device)

20. Presence of any condition that precludes appropriate vascular access

21. Severe mitral regurgitation (regurgitant volume ≥ 60 mL/beat, regurgitant fraction ≥ 50%, and/or effective regurgitant orifice area ≥ 0.40cm2).

22. Previous tricuspid or mitral valve replacement or repair

23. Patients with prosthetic valves

24. Patients with a myxoma

25. Patients with an interatrial baffle or patch as the transseptal puncture couldpersist and produce an iatrogenic atrial shunt

26. Stent, constriction, or stenosis in a pulmonary vein

27. Rheumatic heart disease

28. Hypertrophic cardiomyopathy

29. Diagnosed with amyloidosis or atrial amyloidosis

30. Active systemic infection

31. Renal failure requiring dialysis

32. Severe pulmonary disease (e.g., restrictive pulmonary disease, constrictive orchronic obstructive pulmonary disease) or any other disease or malfunction of thelungs or respiratory system that produces severe chronic symptoms

33. Presence of an implantable therapeutic cardiac device including permanent pacemaker,biventricular pacemaker, or any type of implantable cardiac defibrillator (with orwithout biventricular pacing function) or planned implant of such a device for anytime during the follow-up period. Presence of an implantable loop recorder isacceptable as long as it is removed prior to insertion of the investigationaldevice.

34. Presence of an implanted LAA closure device or plans to have an LAA closure deviceimplanted during the follow-up period

35. Patient is currently participating in another clinical trial or has participated ina clinical trial within 30 days prior to screening that may interfere with thisclinical trial without pre-approval from this study Sponsor

36. Unlikely to survive the protocol follow up period of 12 months

37. Presence of other medical, anatomic, comorbid, social, or psychological conditionsthat, in the investigator's opinion, could limit the subject's ability toparticipate in the clinical investigation or to comply with follow-up requirements,or impact the scientific soundness of the clinical investigation results.

38. Individuals without legal authority

39. Individuals unable to read or write