{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:21:33Z","timestamp":1789042893174,"version":"build-2803163510"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":77,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Cardiothorac Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hybrid ablation is a treatment option for persistent (PsAF) or long-standing persistent atrial fibrillation (LS-PsAF) after failed catheter ablation (CA), but long-term outcomes (&gt;\u20095 years) and predictors of recurrence after hybrid ablation in this population have not been well characterized in prior studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 44 consecutive patients with symptomatic PsAF or LS-PsAF who underwent one-stop unilateral thoracoscopic hybrid ablation with left atrial appendage (LAA) management between May 2015 and April 2021. The procedure consisted of same-day epicardial and endocardial ablation. Primary endpoint was defined as recurrence of atrial arrhythmias\u2009\u2265\u200930\u00a0s after the 3-month blanking period, regardless of antiarrhythmic drug (AAD) use. Given the limited sample size and number of events, multivariable Cox regression was performed as an exploratory analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients (77.3% male; mean age 59.6\u2009\u00b1\u20098.3 years) had median AF duration of 8.0 years; 97.7% had prior failed CA (mean 1.4\u2009\u00b1\u20090.7 procedures). At discharge, 93.2% were in sinus rhythm, with no in-hospital mortality or stroke. Over median 5.2-year follow-up, freedom from arrhythmias at 1, 3, and 5 years was 68.2%, 52.3%, and 50.0%, respectively. Recurrence occurred in 22 patients (50.0%), with 63.6% of recurrences within the first year. On exploratory multivariable Cox regression analysis, left atrial (LA) diameter (HR 1.073, 95% CI: 1.001\u20131.151,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.047) showed a potential association with recurrence. LAA pathology revealed myocardial hypertrophy (84.1%), inflammation (65.9%), and occult thrombus was identified in 10.0% of LAA specimens (4\/40). No thromboembolic events occurred during follow-up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>One-stop hybrid ablation with routine LAA management was associated with acceptable safety and rhythm control in half of patients with PsAF\/LS-PsAF at 5 years within this exploratory cohort. These long-term data suggest hybrid ablation is a viable strategy in this challenging population. Although routine LAA resection\/clipping yielded promising histological findings, definitive clinical benefits could not be confirmed within this single-arm cohort. Given the exploratory nature of the analysis and limited sample size, these findings require validation in larger prospective multicenter studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13019-026-04441-x","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T15:55:08Z","timestamp":1782402908000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-term outcomes of one-stop unilateral thoracoscopic hybrid ablation for persistent atrial fibrillation after failed catheter ablation"],"prefix":"10.1186","volume":"21","author":[{"given":"Lina","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingpeng","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju","family":"Mei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changlin","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fengnan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingrui","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingshu","family":"Lei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CHONGYOU","family":"LEE","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"issue":"8","key":"4441_CR1","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1161\/CIRCULATIONAHA.113.005119","volume":"129","author":"SS Chugh","year":"2014","unstructured":"Chugh SS, Havmoeller R, Narayanan K, et al. 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All patients provided informed consent prior to the procedure.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Clinical Trial Number","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"687"}}