AIMS: Stand-alone minimal invasive epicardial and hybrid atrial fibrillation ablation (EHAFA) has evolved to a recognized treatment option in challenging patients. The EHAFA registry was initiated to describe the applied diagnostic and therapeutic approaches used in routine practice for these procedures, as well as the outcomes in terms of rhythm, symptoms, and complications. METHODS AND RESULTS: Between January 2016 and March 2018, patients who underwent an EHAFA procedure for all types of atrial fibrillation (AF) were consecutively enrolled in the international, prospective, observational EHAFA registry. Follow-up occurred after 1 year. A total of 468 patients were enrolled from 17 centres in 10 countries. Stand-alone ablation (n = 464) was performed epicardially in 47% (n = 220) or as epi-/endocardial hybrid in 53% (n = 244). The predominate type of AF was non-paroxysmal in 74% (n = 342), and 36% (n = 166) of patients had failed previous catheter ablation. The main lesion sets applied consisted of pulmonary vein isolation (99%, n = 460) and isolation of the left atrial (LA) posterior wall (82%, n = 383). In 82% (n = 382), the LA appendage was managed. The overall in-hospital major complication rate was 8.2% (n = 38/464). Freedom from atrial arrhythmias > 30 s with and without antiarrhythmic drug usage was 79% and 64% (n = 279/353, n = 223/351, respectively). The EHRA score at follow-up was clearly reduced compared to preoperatively (EHRA I: 72%, n = 233/325, vs. 3%, n = 14/464). CONCLUSION: This international registry revealed good rhythm control efficacy for epicardial and hybrid AF ablation in patients with advanced AF, leading to improvement in AF-related symptoms. However, a certain associated complication rate needs to be considered.

Cardiac Surgery Department Ceske Budejovice Hospital Ceske Budejovice Czech Republic

Cardiac Surgery Department CHVZ UZ Brussel Brussels Belgium

Cardiac Surgery Department Heart Center Schuechtermann Klinik Bad Rothenfelde Germany

Cardiac Surgery Department Henri Mondor Assistance Publique Hôpitaux de Paris Université Paris 12 Paris France

Department of Cardiac and Vascular Surgery Robert Bosch Hospital Auerbachstraße 110 Stuttgart 70376 Germany

Department of Cardiology Arrhythmia Section Hospital Clínic Universitat de Barcelona Barcelona Spain

Department of Cardiology School of Medical Sciences Faculty of Medicine and Health Örebro University Örebro Sweden

Department of Cardiology Ziekenhuis Oost Limburg Genk Belgium

Department of Medical Science Uppsala University Uppsala Sweden

Faculty of Medicine and Life Sciences Hasselt University Hasselt Belgium

National Heart and Lung Institute Cardiac Function Imperial College London London UK

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