Figure 1. Hybrid ablation: access, tools and lesions sets. Top and middle left: Left thoracoscopic access as part of bilateral clamp-based approach; lesion (large arrow) created by bipolar radiofrequency clamp (Atricure, West Chester, OH) at right pulmonary vein antrum (asterix). RL – right lung. From Pison, J Am Coll Cardiol 2012;60(1):54-61, with permission. Bottom left: Bipolar pen used for linear ablations in bilateral clamp-based approach. From Sakamoto, J Thorac Cardiovasc Surg 2008;136(5):1295–1301, with permission. Bottom middle: Lesion set in bilateral clamp-based approach, from Mahapatra, Ann Thoracic Surg, Volume 91 , Issue 6 , 1890 – 1898, with permission. Central: Suction monopolar radiofrequency catheter (Estech Cobra Adhere XL, Atricure, West Chester, OH) positioned over the posterior left atrium as used in the right-sided thoracoscopic approach. From Muneretto, Innovations (Phila) 2012;7(4):254-8), with permission. Top right: Transabdominal, transdiaphragmatic access used in convergent approach. From Gehi, Heart Rhythm 2013;10(1):22-8, with permission. Middle and bottom right: Vacuum irrigated unipolar radiofrequency device (Numeris Guided Coagulation System with VisiTrax, nContact Surgical, Inc, Morrisville, NC) used in convergent approach; epicardial (blue) and endocardial (red) lesion set in convergent approach. From Gersack, J Thorac Cardiovasc Surg 2014;147(4):1411-6, with permission.