{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T14:40:16Z","timestamp":1767883216884,"version":"3.49.0"},"reference-count":18,"publisher":"IMR Press","issue":"12","license":[{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Cardiovasc. Med."],"abstract":"<jats:p>Background: Atrial fibrillation (AF) represents a major public health burden, especially in its long-standing persistent form, which is often resistant to pharmacological or catheter-based therapies. Hybrid ablation, which integrates minimally invasive surgical and endocardial catheter techniques, has been introduced to address these complex cases. However, data evaluating the long-term comparative effectiveness of immediate versus staged ablation strategies remain limited, and the specific contribution of adjunctive targets, such as Bachmann's bundle (BB), remains unclear. Methods: In this single-center retrospective cohort study, we analyzed 60 patients with long-standing persistent AF who underwent hybrid ablation between 2008 and 2020. All patients received thoracoscopic epicardial ablation followed by endocardial catheter ablation either during the same hospitalization (\u201cimmediate group\u201d, n = 20) or \u22654 weeks later (\u201cstaged group\u201d, n = 40). A subset of patients underwent adjunctive BB ablation. The primary outcome was freedom from documented AF recurrence. Secondary outcomes included procedural complications, hospitalization duration, and long-term survival. Results: At a mean follow-up of 106 \u00b1 12 months, sinus rhythm was maintained in 90.0% of patients in the immediate group and 62.5% in the staged group (p = 0.034). BB ablation was associated with significantly improved rhythm control (90% vs. 70%; p = 0.04). No major adverse events or procedural mortality were reported. The immediate group had significantly shorter hospital stays (5.6 \u00b1 1.5 vs. 8.8 \u00b1 1.3 days; p &lt; 0.001). Subgroup analyses did not reveal significant differences in recurrence among patients without BB ablation. Conclusions: Hybrid ablation provides durable rhythm control and excellent safety over long-term follow-up. BB ablation enhances success and should be considered in procedural planning. Immediate catheter ablation may be a viable strategy in appropriately selected patients, potentially reducing hospitalization time and healthcare resource utilization. Our findings support the need for individualized ablation strategies in complex AF management and underscore the importance of integrating adjunctive targets, such as BB, into advanced procedural workflows.<\/jats:p>","DOI":"10.31083\/rcm43780","type":"journal-article","created":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T11:47:11Z","timestamp":1767181631000},"source":"Crossref","is-referenced-by-count":1,"title":["Hybrid Atrial Fibrillation Ablation: A Decade-Long Single-Center Experience"],"prefix":"10.31083","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3519-770X","authenticated-orcid":true,"given":"Giuseppe","family":"Nasso","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, Anthea Hospital and Santa Maria Hospital GVM Care & Research, 70131 Bari, Italy"},{"name":"Department of Medicine and Surgery, LUM University, Casamassima, 70010 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7262-4424","authenticated-orcid":true,"given":"Walter","family":"Vignaroli","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, San Carlo di Nancy Hospital GVM Care & Research, 00156 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cosimo Domenico","family":"Dicandia","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Anthea Hospital and Santa Maria Hospital GVM Care & Research, 70131 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pasquale","family":"Filannino","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Anthea Hospital and Santa Maria Hospital GVM Care & Research, 70131 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Lembo","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Anthea Hospital and Santa Maria Hospital GVM Care & Research, 70131 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Flavio","family":"Fiore","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Anthea Hospital and Santa Maria Hospital GVM Care & Research, 70131 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario Siro","family":"Brigiani","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Anthea Hospital and Santa Maria Hospital GVM Care & Research, 70131 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ernesto","family":"Greco","sequence":"additional","affiliation":[{"name":"Department of Health and Life Sciences European University of Rome, 00163 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felice","family":"Agr\u00f2","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care Research Unit, Campus Bio-Medico University, 00128 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Santarpino","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Citt\u00e0 di Lecce Hospital, GVM Care & Research, 73100 Lecce, Italy"},{"name":"Department of Clinical and Experimental Medicine, Magna Graecia University, 88100 Catanzaro, Italy"},{"name":"Department of Cardiac Surgery, Paracelsus Medical University, 90419 Nuremberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Speziale","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Anthea Hospital and Santa Maria Hospital GVM Care & Research, 70131 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"16242","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomstr\u00f6m-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. 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