FOCALFLEX (CE Mark) Study

Prior treatment

• Previously diagnosed persistent or long-standing persistent atrial fibrillation (Continuous AF greater than 1 year in duration)
• Left atrial diameter (LAD) ≥ 5.5 cm (anteroposterior diameter) within 180 days prior to the index procedure
• Contraindication to long term anti-thromboembolic therapy
• Known sensitivity to contrast media (if needed during the procedure) that cannot be controlled with pre-medication
• Previous left atrial surgical or left atrial catheter ablation procedure (including left atrial appendage (LAA) closure device)
• Previous tricuspid or mitral valve replacement or repair
• Presence of an implantable therapeutic cardiac device including permanent pacemaker, biventricular pacemaker, or any type of implantable cardiac defibrillator (with or without biventricular pacing function) or planned implant of such a device for any time during the follow-up period. Presence of an implantable loop recorder is acceptable as long as it is removed prior to insertion of the investigational device.
• Patient is currently participating in another clinical trial or has participated in a clinical trial within 30 days prior to screening that may interfere with this clinical trial without pre-approval from this study Sponsor

Other illness

• Arrhythmia due to reversible causes including thyroid disorders, acute alcohol intoxication, electrolyte imbalance, severe untreated sleep apnea, and other major surgical procedures in the preceding 90 days
• Known presence of cardiac thrombus
• New York Heart Association (NYHA) class III or IV heart failure
• Myocardial infarction (MI), acute coronary syndrome, percutaneous coronary intervention (PCI), or valve or coronary bypass grafting surgery within preceding 90 days
• Stroke or TIA (transient ischemic attack) within the last 90 days
• Heart disease in which corrective surgery is anticipated within 180 days after procedure
• History of blood clotting or bleeding abnormalities including thrombocytosis, thrombocytopenia, bleeding diathesis, or suspected anti-coagulant state
• Presence of any condition that precludes appropriate vascular access
• Rheumatic heart disease
• Active systemic infection
• Renal failure requiring dialysis
• Severe pulmonary disease (e.g., restrictive pulmonary disease, constrictive or chronic obstructive pulmonary disease) or any other disease or malfunction of the lungs or respiratory system that produces severe chronic symptoms
• Presence of other medical, anatomic, comorbid, social, or psychological conditions that, in the investigator's opinion, could limit the subject's ability to participate in the clinical investigation or to comply with follow-up requirements, or impact the scientific soundness of the clinical investigation results.

Lab values

• Left ventricular ejection fraction (LVEF) \< 35% as assessed with echocardiography or computerized tomography (CT) within 180 days prior to the index procedure

Other

• Body mass index \> 40 kg/m2
• Pregnant or nursing
• Patients who have had a ventriculotomy or atriotomy within the preceding 28 days of procedure
• Patient unable to receive heparin or an acceptable alternative to achieve adequate anticoagulation
• Plans to have an LAA closure device implanted during the follow-up period
• Severe mitral regurgitation (regurgitant volume ≥ 60 mL/beat, regurgitant fraction ≥ 50%, and/or effective regurgitant orifice area ≥ 0.40cm2).
• Patients with prosthetic valves
• Patients with a myxoma
• Patients with an interatrial baffle or patch as the transseptal puncture could persist and produce an iatrogenic atrial shunt
• Stent, constriction, or stenosis in a pulmonary vein
• Hypertrophic cardiomyopathy
• Unlikely to survive the protocol follow up period of 12 months
• Individuals without legal authority
• Individuals unable to read or write

• Documented symptomatic paroxysmal AF (PAF). Documentation requirements are as follows:
  • Physician's note indicating recurrent self-terminating AF with ≥ 2 episodes of PAF within the 6 months prior to enrollment AND
  • One electrocardiographically documented PAF episode within 12 months prior to enrollment.
• Plans to undergo a catheter ablation procedure due to symptomatic PAF
• At least 18 years of age
• Able and willing to comply with all trial requirements including pre-procedure, post- procedure, and follow-up testing and requirements
• Informed of the nature of the trial, agreed to its provisions, and has provided written informed consent as approved by the Institutional Review Board/Ethics Committee (IRB/EC) of the respective clinical trial site.