The goal of a new study published in the European Journal of Cardio-thoracic Surgery was to derive long-term outcome data of single-step hybrid atrial fibrillation (AF) ablation procedure which combines a transvenous endocardial and thoracoscopic epicardial approach in one procedure. Here, hybrid AF ablation was successfully performed in 64 consecutive patients, of which 53% had persistent AF. The mean follow-up period was 1732 ± 353 days. Perprocedural endocardial touch-up of incomplete epicardial lesions was performed in 26% of these patients. The results showed that in paroxysmal AF patients, arrhythmia-free cumulative survival rates after one hybrid AF ablation, without Class I or III antiarrhythmic drugs procedure and without redo catheter ablation, were 83%, 80%, and 80% after 1, 2 and 3 years, respectively. Whereas, in persistent AF patients, the rates were 82%, 79% and 79% after 1, 2 and 3 years, respectively. Meanwhile, 20% patients had at least one recurrent episode of supraventricular arrhythmia lasting longer than 30 seconds, with the most frequent recurrent arrhythmias being left atrial flutter and AF. On the other hand, no reports of mortality or conversion to cardiopulmonary bypass, phrenic nerve palsy or pacemaker implantation were recorded. Hence, it was concluded that hybrid AF ablation, combining a transvenous endocardial and thoracoscopic epicardial approach in a single procedure, results in a cumulative three-year freedom from arrhythmia without the need for Class I or III antiarrhythmic drugs and without redo catheter ablation of 80% in paroxysmal AF and 79% in non-paroxysmal AF.