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We thank Vroomen et al1 for their letter detailing the benefits of hybrid atrial fibrillation ablation, involving thoracoscopic epicardial ablation combined with endocardial catheter ablation followed by an epicardial left atrial appendage (LAA) clip procedure, performed in an experienced center.2However, wider adoption of this approach as routine clinical practice is not without concerns. Epicardial LAA closure/excision has been performed for many years although follow-up imaging studies have shown that successful closure using a variety of closure techniques may only range between 0% and 73%. Importantly, a significant proportion of patients with unsuccessful closure had evidence …

circulation. arrhythmia and electrophysiology

Response by Panikker et al to Letter Regarding Article, “Left Atrial Appendage Electrical Isolation and Concomitant Device Occlusion to Treat Persistent Atrial Fibrillation: A First-in-Human Safety, Feasibility, and Efficacy Study”