Minimally invasive surgical treatment of lone atrial fibrillation (AF) is indicated in patient at risk of recurrence after catheter ablation of AF.

We compared a surgical bilateral thoracoscopic ablation of AF with a hybrid surgical and endocavitary approach.

Beteween January 2016 and November 2017, 10 patients underwent a bilateral thoracoscopic AF surgical ablation with the Atricure system (Group I). Ablation started with a right thoracoscopic approach, including right pulmonary vein isolation with a bipolar radiofrequency clamp (Sinergy Clamp, Fig. 1a) and left atrium (LA) floor and roof isolation with a bipolar unidirectional catheter (CoolRail, Fig. 1b). After creating the same pattern of lesions on left side, the left atrial appendage (LAA) was excluded with a clip (Atriclip Pro, Fig. 1c). Between March 2018 and April 2019, 11 patients underwent a hybrid ablation of AF (Group II). Ablation started with a left thoracoscopic approach, including left pulmonary vein isolation, LA roof and floor lesion and LAA exclusion. Afterwards, an endocavitary mapping was realized with the Ensite Precision System and HD Grid catheter (St Jude), to check the surgical lesion set. Right pulmonary vein isolation and box completion (Fig. 1d) were realized with a Tacticath unipolar radiofrequency catheter. Preoperative characteristics of both groups are resumed in Table 1.

There were no postoperative major complications. Postoperative results are resumed in Table 1. Mean follow-up was 12 months in Group I and 4 months in Group II. Seven patients in Group I vs. all patients of Group II were free from AF. Eight patients in Group I and 6 patients in Group II were under anticoagulant treatment with VKA or NOACS. Three patients in each group were under anti-arrhythmic drugs.

Hybrid AF ablation seems to be more effective than an isolated surgical ablation. A longer follow-up is mandatory to confirm these results in the long-term.