Cut, Clip, Burn: A Combined Approach to Lung Cancer and Atrial Fibrillation.

Background: Atrial fibrillation is a common comorbidity in patients undergoing pulmonary resection, increasing the risk of thromboembolic events. Although left atrial appendage (LAA) ligation is typically performed during cardiac surgery, its role in thoracic surgery has not been well defined. We describe our institutional experience with concurrent pulmonary resection, LAA ligation, and epicardial ablation in patients with atrial fibrillation. Methods: We conducted a retrospective case series of patients who underwent left-sided pulmonary resection, convergent epicardial ablation, and LAA ligation using the AtriClip (AtriCure) device between July 2022 and March 2025. Demographics, operative data, perioperative outcomes, and short-term follow-up were collected. Results: Four patients met inclusion criteria. All had paroxysmal atrial fibrillation and underwent minimally invasive lung resection with concomitant epicardial ablation and LAA ligation. There were no perioperative strokes, thromboembolic events, or deaths. All patients remained free from atrial fibrillation recurrence during follow-up (range, 1 month-2 years). Three patients discontinued anticoagulation at 6 months. Two were readmitted for self-limited complications. Conclusions: Concurrent pulmonary resection, epicardial ablation, and LAA ligation is feasible and safe in select patients with atrial fibrillation undergoing thoracic surgery. This combined approach may reduce long-term stroke risk and improve rhythm control without significantly increasing perioperative morbidity.