European multicentre experience of staged hybrid atrial fibrillation ablation for the treatment of persistent and longstanding persistent atrial fibrillation

•The 2 stage hybrid method combines epicardial and endocardial ablation.•Its main role is for drug refractory, long-standing persistent AF.•56% were free of atrial arrhythmia recurrence at 18 months post the second stage catheter ablation off antiarrhythmic drugs.•During follow-up 10.8% of patients had redo catheter ablation.•75% of the 175 patents were in sinus rhythm at latest clinical follow-up including those on antiarrhythmic drugs.•Clinically important complications occurred in 5% with 1 death (0.6%).