[Thoracoscopic ablation of atrial fibrillation]

Atrial fibrillation is often a disabling arrhythmia which can be alleviated by ablation procedures. The cornerstone procedure pulmonary vein isolation is generally performed using a transvenous approach transseptally. Endocardial technique can cause as complications arterial embolisation, pulmonary vein stenosis and oesophageal damage. Endocardial isolation has to be repeated often without predictable outcome. Pulmonary vein isolation can be performed with beating heart also mini-invasively in a thoracoscopic way. The procedure is suggested to be combined with ganglionated plexus ablation and resection of left atrial appendage. The results of both endocardial and epicardial isolation of pulmonary veins (hybrid therapy) have been promising. These two techniques are not competing with each other but are complementary. The epicardial procedure has more complications and the choice of therapy line should be considered carefully.