Two-stage Hybrid Ablation or Thoracoscopic Epicardial Ablation for Long-standing Persistent Atrial Fibrillation
Two-stage Hybrid Ablation or Thoracoscopic Epicardial Ablation for Long-standing Persistent Atrial Fibrillation
Hybrid ablation, as an emerging strategy for atrial fibrillation (AF) in recent years, shows
 encouraging outcomes in many medical centers. A lot of cases demonstrated hybrid ablation has
 higher success rate than surgical ablation on patients with persistent AF, especially
 long-standing persistent AF (LSPAF). But it is still lack of high level evidence to prove it.

 This study focus on patients with long-standing persistent atrial fibrillation (LSPAF). In
 order to compare the efficacy and safety of hybrid ablation (two-stage) versus thoracoscopic
 surgical ablation, a randomized, controlled clinical trial will be performed in the
 population of LSPAF patients.
In this study, all selected LSPAF patients will receive thoracoscopic surgical ablation.
 After 3 months of blanking-period, patients off antiarrhythmic therapy freedom from atrial
 arrhythmia (including atrial tachycardia, atrial flutter and atrial fibrillation) will be
 divided into Hybrid group and Surgical group randomly and equally. Patients of Hybrid group
 will receive transcatheter endocardial electrophysiological mapping and catheter ablation
 after randomization subsequently. In followed 2 years, cardiovascular risk control will be
 recommended to 2 groups' patients.

 During the 2-year follow-up, 7d-Holter will be used to monitor patients' rhythm and cardiac
 conditions will be confirmed by transthoracic echocardiography (TTE). Physical examination
 and examinations mentioned above will be performed in 3 months, 6 months, 12 months, 18
 months, 24 months and suspected recurrence.
Inclusion Criteria:

 -  Older than 18 years old.

 -  Nonvalvular and long-standing persistent atrial fibrillation confirmed by
 echocardiography and electrocardiography respectively.

 -  Written informed consent

 Exclusion Criteria:

 -  Secondary atrial fibrillation caused by other reversible diseases.

 -  Left atrial diameter >55mm confrimed by Transthoracic echocardiography.

 -  Intracardial mass or thrombus.

 -  Previous cardiac surgery.

 -  Uncontrolled heart failure or LVEF less than 30%.

 -  Severe chest wall deformity.

 -  Possibly pleural adhesion or pericardial adhesion caused by previous thoracic surgery,
 tuberculosis or constrictive pericarditis.

 -  Severe comorbidities (e.g. severe CAD, severe renal failure, severe liver failure).

 -  Life expectancy less than 2 years (e.g. patients with MODS or cancer)

 -  Unsuitable for radiation exposure (e.g. pregnancy)