{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T03:05:16Z","timestamp":1787799916429,"version":"build-2784847793"},"reference-count":20,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thorac Cardiovasc Surg"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Epicardial surgical ablation is an effective strategy to treat non-paroxysmal forms of atrial fibrillation. Current thoracoscopic epicardial surgical strategies are complex, and are therefore often avoided. With slight modifications to the thoracoscopic maze procedure, totally thoracoscopic all-box clamping may facilitate the performance of epicardial thoracoscopic ablation, while maintaining good results.<\/jats:p>\n                  <jats:p>Between December 2023 and December 2024, 42 patients underwent thoracoscopic all-box clamping at a single center. All-box clamping uses commercially available bipolar radiofrequency clamps for isolation of the ipsilateral pulmonary veins and posterior left atrial wall through right and then left-sided thoracoscopic access. The left atrial appendage is occluded using a clip device, and the ligament of Marshall is transected. Assessment of a bidirectional block confirmed electrical isolation. Data from the CASE-AF registry were analyzed retrospectively. Short-term results pertaining to efficacy and safety are provided.<\/jats:p>\n                  <jats:p>All-box clamping was successfully offered to all patients by three surgeons. There were no reported major or minor complications. The median hospital stay was 6 days (interquartile range 5\u20136). At discharge, a sinus rhythm was observed in 92.9%, and in 76.1% of patients off any class I\/III antiarrhythmic drugs.<\/jats:p>\n                  <jats:p>Surgical ablation with a modified thoracoscopic technique is safe and feasible for the treatment of atrial fibrillation.<\/jats:p>","DOI":"10.1055\/a-2625-9617","type":"journal-article","created":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T20:03:06Z","timestamp":1748980986000},"page":"390-395","source":"Crossref","is-referenced-by-count":3,"title":["Totally Thoracoscopic Ablation for Atrial Fibrillation: All-Box Clamping"],"prefix":"10.1055","volume":"74","clinical-trial-number":[{"clinical-trial-number":"nct03091452","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Nicolas","family":"Doll","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Integrated Heart Center, Schuechtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia","family":"Doll","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Georg-August-Universit\u00e4t G\u00f6ttingen, G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geza","family":"Horvath","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Integrated Heart Center, Schuechtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerold","family":"M\u00f6nnig","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Integrated Heart Center, Schuechtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Pott","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Integrated Heart Center, Schuechtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thorsten","family":"Hanke","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Asklepios Klinikum Hamburg, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taoufik","family":"Ouarrak","sequence":"additional","affiliation":[{"name":"Stiftung Institute f\u00fcr Herzinfarktforschung, Ludwigshafen am Rhein, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jochen","family":"Senges","sequence":"additional","affiliation":[{"name":"Stiftung Institute f\u00fcr Herzinfarktforschung, Ludwigshafen am Rhein, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1797-4560","authenticated-orcid":false,"given":"Mahmoud","family":"Wehbe","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Integrated Heart Center, Schuechtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,6,27]]},"reference":[{"issue":"12","key":"ref1","doi-asserted-by":"crossref","first-page":"e009288","DOI":"10.1161\/CIRCEP.120.009288","article-title":"Hybrid convergent procedure for the treatment of persistent and long-standing persistent atrial fibrillation: results of CONVERGE clinical trial","volume":"13","author":"D B DeLurgio","year":"2020","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1016\/j.jacep.2022.12.011","article-title":"Hybrid ablation versus repeated catheter ablation in persistent atrial fibrillation: a randomized controlled trial","volume":"9","author":"C AJ van der Heijden","year":"2023","journal-title":"JACC Clin Electrophysiol"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"102052","DOI":"10.1016\/j.eclinm.2023.102052","article-title":"Efficacy and safety of hybrid epicardial and endocardial ablation versus endocardial ablation in patients with persistent and longstanding persistent atrial fibrillation: a randomised, controlled trial","volume":"61","author":"N Doll","year":"2023","journal-title":"EClinicalMedicine"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.jacc.2011.12.055","article-title":"Hybrid thoracoscopic surgical and transvenous catheter ablation of atrial fibrillation","volume":"60","author":"L Pison","year":"2012","journal-title":"J Am Coll Cardiol"},{"issue":"S 01","key":"ref5","doi-asserted-by":"crossref","first-page":"i26","DOI":"10.1093\/ejcts\/ezy117","article-title":"Three-year follow-up of hybrid ablation for atrial fibrillation","volume":"53","author":"B Maesen","year":"2018","journal-title":"Eur J Cardiothorac Surg"},{"issue":"06","key":"ref6","doi-asserted-by":"crossref","first-page":"1886","DOI":"10.1016\/j.athoracsur.2012.07.035","article-title":"Approaching a paradigm shift: endoscopic ablation of lone atrial fibrillation on the beating heart","volume":"94","author":"T Weimar","year":"2012","journal-title":"Ann Thorac Surg"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1093\/icvts\/ivw311","article-title":"The totally thoracoscopic maze procedure for the treatment of atrial fibrillation","volume":"24","author":"C van Laar","year":"2017","journal-title":"Interact Cardiovasc Thorac Surg"},{"issue":"11","key":"ref8","doi-asserted-by":"crossref","first-page":"1790","DOI":"10.1093\/europace\/eux385","article-title":"Totally thoracoscopic ablation for atrial fibrillation: a systematic safety analysis","volume":"20","author":"L M Vos","year":"2018","journal-title":"Europace"},{"issue":"14","key":"ref9","first-page":"243","article-title":"CASE-AF Investigators. The German CArdioSurgEry Atrial Fibrillation registry: in-hospital outcomes","volume":"7","author":"M Wehbe","year":"2023","journal-title":"Thorac Cardiovasc Surg"},{"issue":"38","key":"ref10","doi-asserted-by":"crossref","first-page":"2893","DOI":"10.1093\/eurheartj\/ehw210","article-title":"2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","volume":"37","author":"P Kirchhof","year":"2016","journal-title":"Eur Heart J"},{"issue":"36","key":"ref11","doi-asserted-by":"crossref","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"45","author":"I C Van Gelder","year":"2024","journal-title":"Eur Heart J"},{"issue":"13","key":"ref12","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1001\/jama.2019.0693","article-title":"Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA randomized clinical trial","volume":"321","author":"D L Packer","year":"2019","journal-title":"JAMA"},{"issue":"23","key":"ref13","doi-asserted-by":"crossref","first-page":"2235","DOI":"10.1056\/NEJMoa1602014","article-title":"Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation","volume":"374","author":"K-H Kuck","year":"2016","journal-title":"N Engl J Med"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"f366","DOI":"10.1093\/europace\/eux297","article-title":"Outcomes of persistent and long-standing persistent atrial fibrillation ablation: a systematic review and meta-analysis","volume":"20","author":"J A Clarnette","year":"2018","journal-title":"Europace"},{"issue":"02","key":"ref15","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1161\/CIRCULATIONAHA.109.928903","article-title":"Left atrial appendage: an underrecognized trigger site of atrial fibrillation","volume":"122","author":"L Di Biase","year":"2010","journal-title":"Circulation"},{"issue":"07","key":"ref16","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1016\/j.jacep.2020.04.026","article-title":"Mapping endocardial-epicardial dissociation: significance for atrial fibrillation ablation","volume":"6","author":"S Nazarian","year":"2020","journal-title":"JACC Clin Electrophysiol"},{"issue":"02","key":"ref17","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1001\/jama.2022.23722","article-title":"Effect of catheter ablation using pulmonary vein isolation with vs without posterior left atrial wall isolation on atrial arrhythmia recurrence in patients with persistent atrial fibrillation: the CAPLA randomized clinical trial","volume":"329","author":"P M Kistler","year":"2023","journal-title":"JAMA"},{"issue":"02","key":"ref18","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1001\/jamainternmed.2013.1561","article-title":"Discerning the incidence of symptomatic and asymptomatic episodes of atrial fibrillation before and after catheter ablation (DISCERN AF): a prospective, multicenter study","volume":"173","author":"A Verma","year":"2013","journal-title":"JAMA Intern Med"},{"issue":"19","key":"ref19","doi-asserted-by":"crossref","first-page":"1422","DOI":"10.1161\/CIRCULATIONAHA.123.063988","article-title":"Pulsed field ablation for the treatment of atrial fibrillation: PULSED AF pivotal trial","volume":"147","author":"A Verma","year":"2023","journal-title":"Circulation"},{"issue":"47","key":"ref20","doi-asserted-by":"crossref","first-page":"4471","DOI":"10.1093\/eurheartj\/ehaa658","article-title":"Catheter ablation vs. thoracoscopic surgical ablation in long-standing persistent atrial fibrillation: CASA-AF randomized controlled trial","volume":"41","author":"S Haldar","year":"2020","journal-title":"Eur Heart J"}],"container-title":["The Thoracic and Cardiovascular Surgeon"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2625-9617.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T22:37:53Z","timestamp":1785883073000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2625-9617"}},"subtitle":["A Study from the German Cardiosurgical Atrial Fibrillation Registry"],"short-title":[],"issued":{"date-parts":[[2025,6,3]]},"references-count":20,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2026,8,4]]},"published-print":{"date-parts":[[2026,8]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2625-9617","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0171-6425","1439-1902"],"issn-type":[{"value":"0171-6425","type":"print"},{"value":"1439-1902","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,6,3]]},"published":{"date-parts":[[2025,6,3]]}}}