Particularity of the video: Catheter ablation and minimally invasive surgical ablation have become accepted therapy for atrial fibrillation (AF). The presence of a thrombus in the left atrial appendage (LAA) is considered an exclusion criterion for both approaches and for LAA occlusion. The procedure described could represent a new mini-invasive method to treat AF and exclude the LAA.

Brief description: We described a new mini-invasive procedure for a combined radiofrequency treatment of AF and exclusion of LLA with partial thrombosis through a bilateral thoracoscopic approach in a 71-years-old man with AF and partial thrombosis of the LAA. LAA was firstly secured by encircling its base with a 3/0 prolene Ethibinder™. Ablation was obtained by encircling the pulmonary veins origin with Estech-COBRAFusion™ device, delivering both bipolar and monopolar energy. LAA exclusion was finally achieved by deploying the Atricure-AtriClipPRO2™. Postoperative course was uneventful and the patient was discharged in sinus rhythm.