A Study of the THERMOCOOL SMARTTOUCH Surround Flow (SF) Catheter With the TRUPULSE Generator for Treatment of Drug Refractory Symptomatic PAFOUS

Prior treatment

• Previous LA ablation or surgery
• Previously diagnosed with persistent AF (\> 7 days in duration)
• Severe dilatation of the LA (documented LAD \>50mm antero-posterior diameter on imaging within 6 months prior to enrollment
• Documented left atrium (LA) thrombus within 48 hours prior to the index procedure by Transesophageal Echocardiography (TEE), or by Intracardiac Echocardiography (ICE) prior to transeptal puncture during procedure
• Previous PCI/MI within the past 2 months
• Coronary Artery Bypass Grafting (CABG) surgery within past 6 months
• Categorized as vulnerable population and requires special treatment with respect to safeguards of well-being
• Current enrollment in an investigational study evaluating another device or drug

Other illness

• AF secondary to electrolyte imbalance, thyroid disease, or reversible or non-cardiac cause (e.g., untreated documented obstructive sleep apnea and acute alcohol toxicity)
• Uncontrolled heart failure or New York Heart Association (NYHA) Class III or IV
• History of blood clotting, bleeding abnormalities or contraindication to anticoagulation (heparin, warfarin, or dabigatran)
• History of a documented thromboembolic event (including TIA) within the past 12 months, or history of a documented left atrial appendage (LAA) thrombus
• History of a documented symptomatic lacunar infarction within the past 12 months
• Valvular surgery, cardiac surgery (e.g., ventriculotomy, atriotomy) or valvular cardiac (surgical or percutaneous) procedure
• Unstable angina pectoris within the past 6 months
• Anticipated cardiac transplantation, cardiac surgery or other major surgery within the next 12 months
• Significant 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
• Acute illness, active systemic infection or sepsis
• Presence of implanted pacemaker, Implantable Cardioverter-Defibrillator (ICD), recently implanted (within 6 months) LAAO device or other implanted metal cardiac device within the cardiac space that may interfere with the energy field created during the ablation procedure.
• Presence of a condition that precludes vascular access (such as IVC filter)
• History of massive hemorrhage within the past 6 months

Lab values

• Documented severely compromised LVEF (LVEF \<40%) by imaging within 6 months prior to enrollment

Age

• Women who are pregnant (as evidenced by pregnancy test if pre-menopausal), lactating, or who are of childbearing age and plan on becoming pregnant during the course of the clinical investigation

Other

• Patients known to require ablation outside the PV region (atrioventricular reentrant tachycardia, atrioventricular nodal reentry tachycardia, atrial tachycardia, atrial flutter of unknown origin, ventricular tachycardia and Wolff-Parkinson-White)
• Known significant PV anomaly that in the opinion of the investigator would preclude enrollment in this study
• Has known pulmonary vein stenosis
• Pre-existing hemi diaphragmatic paralysis
• Presence of intracardiac thrombus, myxoma, tumor, interatrial baffle or patch or other abnormality that precludes catheter introduction or manipulation
• Severe mitral regurgitation (Regurgitant volume 60 mL/beat, Regurgitant fraction 50%, and/or Effective regurgitant orifice area 0.40cm\^2)
• Significant congenital anomaly or a medical problem that in the opinion of the investigator would preclude enrollment in this study
• Life expectancy less than 12 months
• Presenting contra-indications for the devices

• Diagnosed with Symptomatic PAF (Physician's note indicating recurrent self-terminating AF). At least one (1) electrocardiographically documented AF episode within twelve (12) months prior to enrollment. Electrocardiographic documentation may include, but is not limited to, electrocardiogram (ECG), Holter monitor, or other electrocardiographical devices accepted by investigators
• Failed at least one (1) Class I or Class III Antiarrhythmic Drug (AAD) as evidenced by recurrent symptomatic AF or has intolerable side effects or is contraindicated to the Class I or Class III AAD
• Able and willing to comply with all pre-procedure, post-procedure, and follow-up testing and visit requirements
• Willing and capable of providing consent