{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T16:16:56Z","timestamp":1783786616264,"version":"3.55.0"},"reference-count":33,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2016,2,25]],"date-time":"2016-02-25T00:00:00Z","timestamp":1456358400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:title>Hybrid versus Endocardial Ablation for LSPAF<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Ablation of longstanding persistent atrial fibrillation (LSPAF) is the most challenging procedure in the treatment of AF, either by surgical or by percutaneous approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>We investigated the difference in success and complication rates between combined surgical epicardial and endocardial catheter ablation procedure and our standard endocardial ablation procedure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and Results<\/jats:title><jats:p>Twenty\u2010four consecutive patients (group 1) with LSPAF and enlarged left atrium (&gt;4.5 cm) underwent a combined procedure, consisting of surgical, closed\u2010chest, epicardial, radiofrequency ablation (nContact, NC, USA) via pericardial access, and concomitant endocardial ablation (hybrid procedure). Procedural complications and long\u2010term outcomes were compared to those of 35 consecutive patients who refused the hybrid procedure and underwent standard endocardial only ablation (group 2). Baseline characteristics were comparable. In group 1, 1 patient (4.2%) developed post\u2010procedural cardio\u2010embolic stroke and 3 (12.5%) died (1 atrio\u2010esophageal fistula, 1 fatal stroke, 1 of unknown cause in early follow\u2010up), while no strokes or deaths occurred in group 2. Overall complication rates were higher for group 1 (P = 0.036). At 24\u2010month follow\u2010up, 4 (19%) patients in group 1 and 19 (54.3%) in group 2 were arrhythmia\u2010free after a single procedure, on or off antiarrhythmic drugs (P&lt;0.001). Total procedural time (276.9 \u00b1 63.5 vs. 203.15 \u00b1 67.3 minutes) and length of hospital stay (5 [IQR 3\u20138] vs. 1 [IQR 1\u20133] days were significantly shorter for group 2 (P &lt;0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In patients with LSPAF and enlarged left atrium, a concomitant combined surgical\/endocardial ablation approach increases complication rate and does not improve outcomes when compared to extensive endocardial ablation only.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.12926","type":"journal-article","created":{"date-parts":[[2016,1,14]],"date-time":"2016-01-14T15:56:58Z","timestamp":1452787018000},"page":"524-530","source":"Crossref","is-referenced-by-count":56,"title":["Hybrid Procedure (Endo\/Epicardial) versus Standard Manual Ablation in Patients Undergoing Ablation of Longstanding Persistent Atrial Fibrillation: Results from a Single Center"],"prefix":"10.1111","volume":"27","author":[{"given":"ZACHARY","family":"EDGERTON","sequence":"first","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute St. David's Medical Center  Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ALESSANDRO PAOLETTI","family":"PERINI","sequence":"additional","affiliation":[{"name":"Department of Heart and Vessels University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"RODNEY","family":"HORTON","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute St. David's Medical Center  Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CHINTAN","family":"TRIVEDI","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute St. David's Medical Center  Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"PASQUALE","family":"SANTANGELI","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute St. David's Medical Center  Austin Texas USA"},{"name":"Hospital of the University of Pennsylvania  Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"RONG","family":"BAI","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute St. David's Medical Center  Austin Texas USA"},{"name":"Beijing Anzhen Hospital Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CAROLA","family":"GIANNI","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute St. David's Medical Center  Austin Texas USA"},{"name":"University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SANGHAMITRA","family":"MOHANTY","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute St. David's Medical Center  Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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