{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T03:05:06Z","timestamp":1787799906860,"version":"build-2784847793"},"reference-count":6,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to evaluate the long-term efficacy and safety of isolated and hybrid thoracoscopic atrial fibrillation (AF) ablation using a bipolar irrigated radiofrequency clamp in a multicentre registry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective multicentre registry of patients undergoing AF ablation using the bipolar clamp was conducted over the past 13 years (2010-2023). The primary efficacy outcome was freedom of atrial tachyarrhythmias (ATAs), with and without the use of Class I\/III antiarrhythmic drugs (AADs). Antiarrhythmic drug use during follow-up was not uniformly documented across centres. The primary safety outcome was the rate of periprocedural complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The cohort of 678 patients consisted of a minority of female patients (17.4%), with most patients having longstanding persistent AF (LSPAF) (66.7%), a mean duration of 61 months of AF duration and 33.3% had undergone prior catheter ablation. Freedom from ATA while allowing Class I\/III AAD use was 82.3%, 71.5%, and 52.4% at 1, 3, and 5 years, respectively. Freedom from ATA off Class I\/III AAD declined from 71.7% at 1 year to 44.2% at 5 years, underscoring the progressive nature of AF and the need for long-term rhythm strategies. Women presented with a more advanced cardiovascular risk profile than men, including older age (60.3 vs 57.3 years), higher CHA2DS2-VA-scores, and more comorbidities. Despite these differences, there were no significant sex-based differences in long-term ATA freedom. There were no significant unadjusted differences in long-term ATA freedom between paroxysmal AF (PAF) and non-PAF. Major complication rate was low.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Isolated and hybrid thoracoscopic AF ablation using the Gemini Clamp demonstrated favourable outcomes with a low complication rate. However, variability in ATA detection methods among centres may have influenced the primary outcome and should be considered when interpreting long-term efficacy results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registry number<\/jats:title>\n                    <jats:p>METC-number 2022-3561.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejcts\/ezag161","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T11:44:48Z","timestamp":1777031088000},"source":"Crossref","is-referenced-by-count":1,"title":["Safety and Efficacy of Stand-Alone and Hybrid Thoracoscopic Atrial Fibrillation Ablation"],"prefix":"10.1093","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0360-1824","authenticated-orcid":false,"given":"Luca","family":"Aerts","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Maastricht University Medical Centre , Maastricht 6202 AZ,","place":["The Netherlands"]},{"name":"Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht 6229 ER,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2628-9562","authenticated-orcid":false,"given":"Michal J","family":"Kawczynski","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Maastricht University Medical Centre , Maastricht 6202 AZ,","place":["The Netherlands"]},{"name":"Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht 6229 ER,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1717-7326","authenticated-orcid":false,"given":"Niels J","family":"Verberkmoes","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Catharina Ziekenhuis , Eindhoven 5623 EJ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6933-1797","authenticated-orcid":false,"given":"Thomas","family":"Van Brakel","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Catharina Ziekenhuis , Eindhoven 5623 EJ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9598-2286","authenticated-orcid":false,"given":"Justin G L M","family":"Luermans","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht 6229 ER,","place":["The Netherlands"]},{"name":"Department of Cardiology, Maastricht University Medical Centre , Maastricht 6202 AZ,","place":["The 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Surgery, Onze Lieve Vrouwe Gasthuis , Amsterdam 1091 AC,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0504-0955","authenticated-orcid":false,"given":"Sacha P","family":"Salzberg","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Klinik Hirslanden , 8032 Z\u00fcrich,","place":["Switzerland"]},{"name":"Department of Cardiothoracic Surgery, Sch\u00f6n Klinik Vogtareuth , 83569 Vogtareuth,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9169-265X","authenticated-orcid":false,"given":"Henri","family":"Gruwez","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Cardiac Surgery, Ziekenhuis Oost-Limburg , 3600 Genk,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5117-6780","authenticated-orcid":false,"given":"Herbert","family":"Gutermann","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Cardiac Surgery, Ziekenhuis Oost-Limburg , 3600 Genk,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8518-3330","authenticated-orcid":false,"given":"Laurent","family":"Pison","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Cardiac Surgery, Ziekenhuis Oost-Limburg , 3600 Genk,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5343-5070","authenticated-orcid":false,"given":"Dmitry","family":"Elesin","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Cardiothoracic Surgery, Meshalkin National Medical Research Center , Novosibirsk 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