Design and inclusion/exclusion criteria
We conducted a single-center, prospective, observational study at the Arrhythmology Unit of the Mediterranea Center, Naples, Italy, enrolling consecutive patients with symptomatic persistent or longstanding persistent AF, who were referred for endo-/epicardial CA after at least one prior endocardial procedure. Exclusion criteria included prior cardiac surgery or other pericardial diseases predisposing to pericardial adhesions.
The study was carried out according to institutional standards, national legal requirements, and the Declaration of Helsinki. Informed consent was obtained from all patients. Being an observational study, approval of the ethics committee was waived.