Limitations
We could only enroll 25 patients from a single hospital in our study, with a short median duration of follow-up, and therefore larger numbers of patients enrolled in multiple centers with longer observation times would have been required to derive statistically rigorous results in support of the stepwise endo-/epicardial approach for AF CA. All procedures were performed by expert operators, potentially limiting the generalizability of our findings. The majority of patients did not have cardiac implanted devices, which might have led to an underestimation of subclinical AF recurrences. However, AF/atrial tachycardia recurrences in a cohort of patients with persistent AF and markedly dilated LA could expectably present as non-self-limiting episodes, which would likely be detectable by intermittent rhythm monitoring.