Dual Epicardial Endocardial Persistent Atrial Fibrillation(AF) Study (Staged DEEP)

Inclusion Criteria: * Age \> 18 year * Patients with symptomatic persistent or longstanding persistent AF refractory to a minimum of one Class I or III antiarrhythmic drug (AAD). * Patients with failed catheter ablation attempts are eligible if the patients are symptomatic with persistent or longstanding persistent AF. (catheter ablation procedure must be more than 3 months prior to index procedure) * Life expectancy of at least two years * Patient will and able to provide informed consent * Patient is willing and able to attend the scheduled follow-up visits Exclusion Criteria: * Prior Cardiothoracic Surgery * Patient has NYHA (New York Heart Association) Class IV heart failure * Evidence of underlying structural heart disease requiring surgical treatment * Surgical procedure within the 30 days prior to the index procedure * Ejection fraction \< 30% * Measured left atrial diameter \> 6.0 cm * Renal Failure * Stroke within previous 6 months * Known carotid artery stenosis greater than 80% * Evidence of significant active infection or endocarditis * Pregnant woman or women desiring to become pregnant in the next 24 months * Presence of thrombus in the left atrium determined by echocardiography * History of blood dyscrasia * Contraindication to anticoagulation, based on Investigator's opinion * Mural thrombus or tumor * Moderate to Severe COPD