Background: Variable outcomes exist following endocardial ablation (endo) in medically refractory persistent atrial fibrillation (AF) patients. A hybrid epicardial-endocardial approach (hybrid) has emerged as an alternative to endocardial ablation. This retrospective feasibility study aimed to assess outcomes.

Methods: In 133 consecutive patients, 69 received endocardial ablation alone (pulmonary vein isolation and radiofrequency [RF] ablation), and 64 received both endo and epicardial ablation of the posterior left atrial wall using a subxyphoid approach with irrigated RF. Recurrence was defined as any arrhythmia following the 3-month blanking period.

Results:Patients were followed for a median (Q1,Q3) of 16 (12,24) months. Hybrid and endo groups were similar in mean (±SD) age (61±10 vs 62±8) years, body mass index (35±6 vs 35±7), CHA2D2-VASc (2±1 vs 2±1) and ejection fraction (54±11 vs 53±8, %). Hybrids had a longer AF duration (months) [12 (8,28) vs 7 (5,12), p

Conclusions: Among persistent AF patients, hybrid ablation is associated with less AF recurrence. Further prospective randomized trials are needed to validate these results.