Combined Endoscopic Epicardial and Percutaneous Endocardial Ablation Versus Repeated Catheter Ablation in Persistent and Longstanding Persistent Atrial Fibrillation

Prior treatment

• Patient underwent previous ablation procedure or heart surgery
• Contraindication for either catheter ablation or epicardial surgery (including, but not limited to: previous thoracic radiation, previous perimyocarditis, Previous cardiac tamponade, Pleural adhesions, Prior thoracotomy)
• History of cerebrovascular disease, including stroke or transient ischemic attack (TIA) within 6 months prior to enrollment
• Contraindication to anticoagulant therapy, or inability to comply with anticoagulant therapy
• Patient is involved in another study involving an investigational drug or device

Other illness

• AF is secondary to electrolyte imbalance, thyroid disease, or other reversible or non-cardiovascular cause
• Patient needs other cardiac surgery procedures besides AF treatment (valve, coronary, others)
• Active infection or sepsis
• Other clinical conditions precluding inclusion (e.g., organ disease, disturbances of hemostasis)

Lab values

• Left ventricular ejection fraction \< 30 %

Age

• Patient has longstanding persistent AF \> 10 years

Other

• Patient presenting with paroxysmal AF
• Patient with persistent AF and a LA-diameter ≤ 4cm
• Body mass index \> 35
• LA Diameter \> 6 cm
• Severe mitral regurgitation (\>II)
• Patient unable to undergo TransEsophageal Echocardiogram (TEE)
• Presence of LA thrombus by TEE, CT scan, MRI or angiography
• Pregnancy, planned pregnancy or breastfeeding
• Life expectancy is less than 12 months

• Patient has a history of symptomatic Persistent AF and a left atrium (LA) \> 4cm or Long Standing Persistent AF as defined by the HRS/EHRA/ECAS expert consensus statement
• Patient is refractory to or intolerant of at least one antiarrhythmic drug (class I or III)
• Patient is mentally able and willing to give informed consent