title: Initial experience with total thoracoscopic ablation.
abstract: BACKGROUND
  Recently, a hybrid surgical-electrophysiological (EP) approach for confirming ablation lines in patients with atrial fibrillation (AF) was suggested. The aim of this approach was to overcome the limitations of current surgery- and catheter-based techniques to yield better outcomes.
  
  
  METHODS
  Ten consecutive patients with AF underwent total thoracoscopic ablation (TTA) following transvenous catheter EP ablation (residual gap and cavotricuspid isthmus [CTI] ablation). Holter monitoring was performed 6 months postoperatively.
  
  
  RESULTS
  Ten patients (90% with persistent AF) underwent successful hybrid procedures, and there was no in-hospital mortality. An EP study was performed in 8 patients and showed that successful antral ablation in all pulmonary veins was achieved in 7 of them. The median follow-up duration was 7.63 months (range, 6.7 to 11.6 months). Nine patients underwent Holter monitoring 6 months postoperatively, and the results indicated an underlying sinus rhythm without AF, atrial flutter, or atrial tachycardia lasting more than 30 seconds in all of the patients. There was no recurrence of AF during follow-up.
  
  
  CONCLUSIONS
  A hybrid approach that consists of TTA followed by transvenous catheter EP ablation (residual gap and CTI ablation) yielded excellent outcomes in our patient population. A hybrid approach should be considered in patients with a high risk of AF recurrence.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
authors.forename: Hee Moon
authors.initials: HM
authors.lastname: Lee
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
authors.forename: Su Ryeun
authors.initials: SR
authors.lastname: Chung
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
authors.forename: Dong Seop
authors.initials: DS
authors.lastname: Jeong
keywords: Ablation; Atrial fibrillation; Thoracoscopy