SPHERE Per-AF Post-Approval Study

Inclusion Criteria:

1. A diagnosis of recurrent symptomatic persistent AF (continuous AF sustained longerthan 7 days but less than 12 months)

2. Refractory (i.e. not effective, not tolerated, or not desired) to at least one ClassI or III antiarrhythmic drug (AAD)

3. Patient is ≥ 18 years of age

4. Planned de novo pulmonary vein isolation procedure using commercially availableSphere-9™ Catheter and Affera Ablation System

5. Patient is willing and able to comply with study requirements and give informedconsent

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/insertablecardiac monitor (ICM), or any type of implantable cardiac defibrillator (with orwithout biventricular pacing function)

5. Current or anticipated participation in any other clinical trial of a drug, deviceor biologic during the duration of this study not pre-approved by Medtronic