Conclusion
A stepwise percutaneous endo-/epicardial stepwise approach for CA of persistent and longstanding persistent AF resulted in restoration and maintenance of sinus rhythm in the majority of patients at 9-month follow-up. BB ablation appeared to be a pivotal component of such an approach, and was feasible in all patients, with low risk of serious procedural complications. Further studies are highly needed to confirm our promising results, which could represent an important step forward in the management of AF in patients with persistent or longstanding persistent forms of the arrhythmia after a failed endocardial AF CA.