Subxyphoid Hybrid MAZE Registry for Patients With Persistent Atrial Fibrillation

Inclusion criteria

Subjects must meet all of the following criteria to be eligible for the study: 1. Age ≥ 18 years and ≤ 80 years at time of screening. 2. Documented diagnosis of symptomatic persistent or persistent longstanding non-valvular atrial fibrillation * Persistent AF is defined as atrial fibrillation sustained for ≥ 7 days and ≤ 1 year; * Longstanding persistent AF is defined as continuous atrial fibrillation \> 1 year duration; * Non-valvular atrial fibrillation is defined as cases without a mechanical heart valve requiring anticoagulation or without moderate to severe mitral stenosis. Note: Persistent AF and Longstanding Persistent AF must be documented as follows: Persistent AF: * Physician's note indicating that patient has experienced symptomatic continuous AF that is sustained ≥ 7 days duration and \< 1 year and clinical history of non-paroxysmal AF \< 3 years; and * A ≥7-day continuous rhythm monitoring (e.g., Zio patch, implantable loop recorder (ILR), pacemaker) which documents 90% AF burden over at least 7 consecutive days or alternatively, two electrocardiograms from any form of rhythm monitoring (e.g. 12-lead ECG, Holter, event monitor) documenting continuous AF, with electrocardiograms taken at least 7 days apart, for subjects with sustained AF ≥ 7 days, as confirmed by the ECG Core Laboratory, obtained within 90 days prior to randomization. Longstanding Persistent AF: * Physician's note indicating that patient has experienced symptomatic continuous AF that is sustained \> 1 year duration and clinical history of non-paroxysmal AF \< 3 years; and * A ≥7-day continuous rhythm monitoring (e.g., Zio patch, ILR, pacemaker) which documents 90% AF burden over at least 7 consecutive days or alternatively, 24 hour continuous rhythm monitoring (e.g. holter, event monitor) obtained within 90 days prior to the index procedure showing continuous AF, as confirmed by the ECG Core Laboratory. Note: The performance of a successful cardioversion (sinus rhythm ≥30 seconds) within 12 months of an ablation procedure with documented early recurrence of AF within 30 days should not alter the classification of AF as Longstanding Persistent.) 3. Failed previous catheter PVI ablation 4. Life expectancy ≥ 1 year; 5. Willing and able to return to and comply with scheduled follow-up visits and tests; and 6. Willing and able to provide written informed consent