Totally Thoracoscopic Atrial Fibrillation Ablation With the Gemini S Bipolar Clamp: A Single-Center Descriptive Cohort Study of 1-Year Rhythm, Safety, and Quality-of-Life Outcomes.

Background: Outcome data for the Gemini S bipolar radiofrequency clamp are almost absent; the only indexed report being a three-patient case series. We describe 1-year outcomes in a consecutive cohort. Methods: We retrospectively analyzed all consecutive patients treated with the Gemini S clamp between January 2021 and August 2024. Epicardial box isolation was combined with left atrial appendage (LAA) exclusion; completeness was confirmed by entry and exit block on epicardial three-dimensional mapping. The primary outcome was freedom from AF recurrence at 12 months, on and off antiarrhythmic drugs (AADs) after a 90-day blanking period. Results: Twenty-three patients were included (mean age 64.4 ± 8.0 years; 82.6% male). AF was paroxysmal in 34.8%, persistent in 26.1%, and long-standing persistent in 39.1%; 60.9% had prior catheter ablation and 69.6% had failed or were intolerant to a Class I or III agent. A complete block-verified box lesion was achieved in 95.7% and LAA exclusion in 91.3%. Three patients (13.0%) required conversion to sternotomy for bleeding, exceeding larger series. There was no death, stroke, phrenic nerve palsy, or pacemaker implantation. At 1 year, 87.0% (95% CI 67.9-95.5) were in sinus rhythm, all off Class I/III AADs. Conclusions: Sinus rhythm was achieved in 87.0% of patients at 1 year. As the largest reported experience with this device, the series provides device-level evidence where little existed, but it is descriptive, not powered for comparison, and the conversion rate needs confirmation.