Dear Sir,
I read with great interest the elegant article of Umbrain et al.1 on hybrid AF treatment in issue 6.4 of AER. It delineates in a comprehensive but succinct manner the technical problems and peculiarities of this promising approach. However, in my capacity as a general cardiologist and director of a primary care centre, I am very much concerned about the costs of such procedures. In the current era of fiscal constraints and continuous budget cuts regarding healthcare internationally, we must prove the cost-effectiveness of medical innovations and complicated approaches before advocating their clinical use. This is true, particularly when considering “integrated approaches involving different teams”. Have the authors taken into account the financial burden of the proposed method, particularly when the anticipated success rates, judging from RCTs on conventional ablation, range between 57 and 77 % following single and multiple procedures, respectively?2