**3. Conclusions**

The aim of the present treatise is to show that, thanks to the evolution in arrhythmia pathophysiology understanding, it has been possible to develop a series of different technological tools and options able to treat even long-standing persistent lone or concomitant AF, permitting a tailored procedural offer to every single patient including pure endocardial ablation, pure surgical procedures (especially for concomitant cases), or a cooperation of both (hybrid strategies).

Undoubtedly, the way is still long, since several aspects of the treatment require improvements: concerning concomitant chronic AF, first of all, rate success should be augmented by trying to develop energy sources and technologies able to achieve transmurality in the totality of cases; secondly, it should be important to join an unanimous consensus onto lesions set schema to apply, but such objective cannot be independent from a full comprehension of arrhythmia pathogenesis.

Even with reference to lone AF, understanding arrhythmia mechanisms is crucial in view of developing less invasive techniques [21]. More in detail, recent studies are now more focused on the role of autonomic ganglia in being the true triggers and perpetuators of AF and perhaps they will rapidly become the main target of future ablation techniques.

Furthermore, results of the hybrid approach are encouraging but far from perfect, especially in case of persistent and long-standing persistent AF and need to be confirmed in larger and stronger trials also allowing comparison with last-generation catheter-based ablation tools. Nevertheless, we can speculate that the success rate in the treatment of lone AF may probably rely on a close collaboration between surgeons and electrophysiologists, implying the use of "a common language" and information exchange.

In conclusion, by highlighting that midterm success results in terms of SR maintenance without antiarrhythmic drugs are satisfactory, ranging from 60 to 90% depending from AF type and ablation technique, such a comprehensive essay would like to represent a useful instrument for clinicians, allowing them to hypothesize and recommend an adapted treatment to their fibrillating patients.
