AtriCure CryoICE Lesions for Persistent and Long-standing Persistent Atrial Fibrillation Treatment

Inclusion Criteria: 1. Subject is greater than or equal to 18 years of age 2. Subject has history of persistent or long-standing persistent atrial fibrillation as defined by the 2017 Heart Rhythm Society (HRS)/European Heart Rhythm Association (EHRA)/ European Cardiac Arrhythmia Society (ECAS) Guidelines 3. Stable Subject that is scheduled to undergo non-emergent cardiac surgical procedure(s) to be performed on cardiopulmonary bypass including open-heart surgery for one or more of the following: Mitral valve repair or replacement, Aortic valve repair or replacement, Tricuspid valve repair or replacement, and Coronary artery bypass procedures 4. Left Ventricular Ejection Fraction ≥ 30% (determined by echocardiography or cardiac catheterization performed within 60 days of enrollment as documented in patient medical history) 5. Subject is willing and able to provide written informed consent 6. Subject has a life expectancy of at least 5 years 7. Subject is willing and able to return for scheduled follow-up visits. Exclusion Criteria: 1. Stand-alone AF without indication(s) for concomitant Coronary Artery Bypass Graft (CABG) and/or valve surgery 2. Previous surgical Maze procedure 3. Wolff-Parkinson-White syndrome or other Supra-Ventricular arrhythmia, Atrioventricular (AV) nodal reentry 4. Prior cardiac surgery (Redo) 5. Subjects requiring surgery other than CABG and/or cardiac valve surgery and/or patent foramen ovale repair, and/or atrial septal defect repair. 6. Class IV New York Heart Association (NYHA) heart failure symptoms 7. Prior history of cerebrovascular accident within 6 months or at any time if there is residual neurological deficit 8. Documented ST-segment elevation Myocardial Infarction (MI) within the 6 weeks prior to study enrollment 9. Need for emergent cardiac surgery (i.e. cardiogenic shock) 10. Known carotid artery stenosis greater than 80% 11. Documented AF duration of greater than ten years 12. LA diameter \>7 cm by Transthoracic echocardiography (TTE) 13. Current diagnosis of active systemic infection 14. Severe peripheral arterial occlusive disease defined as claudication with minimal exertion 15. Renal failure requiring dialysis or hepatic failure 16. A known drug and/or alcohol addiction 17. Mental impairment or other conditions which may not allow the subject to understand the nature, significance and scope of the study 18. Pregnancy or desire to get pregnant within 12-months of the study treatment 19. Preoperative need for an intra-aortic balloon pump or intravenous inotropes 20. Requires anti-arrhythmic drug therapy for the treatment of a ventricular arrhythmia 21. Subjects who have been treated with thoracic radiation 22. Subjects in current chemotherapy 23. Subjects on long term treatment with oral or injected steroids (not including intermittent use of inhaled steroids for respiratory diseases) 24. Subjects with known connective tissue disorders 25. Subjects with known hypertrophic obstructive cardiomyopathy 26. Subjects with known cold agglutinin