Bariatric Atrial Restoration of Sinus Rhythm

Inclusion Criteria:

   - Symptomatic persistent or paroxysmal AF refractory to at least one antiarrhythmic
   agent

   - EF > 40%

   - BMI > 40 or BMI > 35 and at least one of the following co-morbidities:

      - Type 2 Diabetes Mellitus (by American Diabetes Association diagnostic criteria).

      - Systolic blood pressure of 130 mmHg and/or diastolic blood pressure 80 mmHg or
      higher despite medical treatment with maximal doses of three antihypertensive
      medications).

      - Refractory hyperlipidemia (acceptable levels of lipids unachievable with diet and
      maximum doses of lipid lowering medications).

      - Obesity-induced cardiomyopathy.

      - Clinically significant obstructive sleep apnea.

      - Obesity-related hypoventilation.

      - Pseudotumor cerebri (documented idiopathic intracerebral hypertension).

      - Severe arthropathy of spine and/or weight-bearing joints (when obesity prohibits
      appropriate surgical management of joint dysfunction treatable but for the
      obesity).

      - Hepatic steatosis without evidence of active inflammation.

      - Hypertriglyceridemia

      - Polycystic Ovary Syndrome (PCOS)

      - Asthma

      - Coronary Artery Disease (CAD)

Exclusion Criteria:

   - Prior bariatric surgery

   - Prior AF catheter ablation

   - BMI > 65 kg/m2

   - Contraindication to bariatric surgery or AF ablation

   - Contraindication to therapeutic anticoagulation

   - Sustained AF lasting more than 3 years

   - Left atrial diameter of greater than or equal to 60 mm or LA volume greater than or
   equal to 60 ml/m2