Hybrid one-stage atrial fibrillation ablation.

Persistent and long-standing persistent atrial fibrillation are associated with numerous adverse outcomes and significantly impaired quality of life. Endocardial catheter ablation (CA) alone has limited efficacy in this population. Hybrid approaches combining epicardial ablation, including left atrial appendage exclusion, with complementary endocardial CA have demonstrated improved outcomes. This video tutorial illustrates a hybrid technique involving left atrial dome ablation and left atrial appendage exclusion via left thoracotomy, along with posterior left atrial wall ablation through a subxiphoid approach. Endocardial CA is subsequently performed during the same procedure.