1- and 2-stage hybrid atrial fibrillation ablation using a biparietal irrigated radiofrequency clamp: A dual-center cohort analysis.

Background: Hybrid thoracoscopic ablation (HA), by using a biparietal irrigated radiofrequency (RF) device for epicardial ablation combined with endocardial techniques, has emerged as a promising treatment for atrial fibrillation (AF). However, findings from the endocardial validation are lacking. Objective: This study aimed to evaluate findings of endocardial validation after epicardial isolation of the pulmonary veins (PVs) and the left atrial posterior wall (LAPW) during HA, performed either as a 1- or 2-stage procedure using a biparietal irrigated RF clamp. Methods: In this multicenter study, 57 patients with paroxysmal, persistent, or long-standing persistent AF underwent 1-stage (n = 28) or 2-stage HA (n = 29). During the endocardial part, mapping was performed to assess entrance and exit blocks of the PVs and LAPW and thus evaluate lesion completeness. Periprocedural findings, complications, redo ablations, and clinical outcomes were evaluated. Results: Patients in the 1-stage group had a longer AF duration (117 vs 33 months; Conclusion: HA using an irrigated RF clamp achieved a high percentage of PV and LAPW isolation during the 1- and 2-stage procedures, confirmed by endocardial validation, with low complication rates and sustained lesion integrity during follow-up.