{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T02:20:12Z","timestamp":1782354012060,"version":"3.54.5"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2015,3,10]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Catheter ablation of persistent atrial fibrillation yields an unsatisfactorily high number of failures. The hybrid approach has recently emerged as a technique that overcomes the limitations of both surgical and catheter procedures alone.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We investigated the sequential (staged) hybrid method, which consists of a surgical thoracoscopic radiofrequency ablation procedure followed by radiofrequency catheter ablation 6 to 8\u00a0weeks later using the\n              <jats:styled-content style=\"fixed-case\">CARTO<\/jats:styled-content>\n              3 mapping system. Fifty consecutive patients (mean age 62\u00b17\u00a0years, 32 males) with long\u2010standing persistent atrial fibrillation (41\u00b134\u00a0months) and a dilated left atrium (&gt;45\u00a0mm) were included and prospectively followed in an unblinded registry. During the electrophysiological part of the study, all 4 pulmonary veins were found to be isolated in 36 (72%) patients and a complete box\u2010lesion was confirmed in 14 (28%) patients. All gaps were successfully re\u2010ablated. Twelve months after the completed hybrid ablation, 47 patients (94%) were in normal sinus rhythm (4 patients with paroxysmal atrial fibrillation required propafenone and 1 patient underwent a redo catheter procedure). The majority of arrhythmias recurred during the first 3\u00a0months. Beyond 12\u00a0months, there were no arrhythmia recurrences detected. The surgical part of the procedure was complicated by 7 (13.7%) major complications, while no serious adverse events were recorded during the radiofrequency catheter part of the procedure.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">The staged hybrid epicardial\u2013endocardial treatment of long\u2010standing persistent atrial fibrillation seems to be extremely effective in maintenance of normal sinus rhythm compared to radiofrequency catheter or surgical ablation alone. Epicardial ablation alone cannot guarantee durable transmural lesions.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Clinical Trial Registration<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.ablace.cz\">www.ablace.cz<\/jats:ext-link>\n              Unique identifier: cz\u2010060520121617\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.114.001754","type":"journal-article","created":{"date-parts":[[2015,3,26]],"date-time":"2015-03-26T09:14:46Z","timestamp":1427361286000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":69,"title":["Sequential Hybrid Procedure for Persistent Atrial Fibrillation"],"prefix":"10.1161","volume":"4","author":[{"given":"Alan","family":"Bulava","sequence":"first","affiliation":[{"name":"Department of Cardiology, Ceske Budejovice Hospital, Ceske Budejovice, Czech Republic"},{"name":"Faculty of Health and Social Studies, University of South Bohemia, Ceske Budejovice, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ales","family":"Mokracek","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Ceske Budejovice Hospital, Ceske Budejovice, Czech Republic"},{"name":"Faculty of Health and Social Studies, University of South Bohemia, Ceske Budejovice, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiri","family":"Hanis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ceske Budejovice Hospital, Ceske Budejovice, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vojtech","family":"Kurfirst","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Ceske Budejovice Hospital, Ceske Budejovice, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Eisenberger","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ceske Budejovice Hospital, Ceske Budejovice, Czech Republic"},{"name":"Faculty of Health and Social Studies, University of South Bohemia, Ceske Budejovice, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ladislav","family":"Pesl","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ceske Budejovice Hospital, Ceske Budejovice, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.285.18.2370"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi825"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eus305"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eup349"},{"key":"e_1_3_4_6_2","first-page":"33","article-title":"Characterization of residual coronary sinus\u2010related tachycardia during ablation of longstanding persistent atrial fibrillation","volume":"57","author":"Fiala M","year":"2011","unstructured":"Fiala M, Chovancik J, Wojnarova D, Bulkova V, Pindor J, Szymeczek H, Labrova R, Toman O, Januska J, Spinar J. 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