48 year old male with symptomatic persistent atrial fibrillation refractory to medical therapy. His symptoms were significantly affecting his daily quality of life. Because of his active lifestyle he was hesitant to take anticoagulation. He was referred for hybrid ablation therapy (Convergent Procedure) along with left atrial appendage (LAA) occlusion. He underwent minimally invasive endoscopic ablation of the posterior left atrium via subxiphoid approach just prior to the start of this video presentation. After closure of the subxiphoid incision, the left VATS portion of the operation was started. Three 5 mm ports were inserted in the 2nd, 4th, and 6th left intercostal spaces along the mid-axillary line and CO₂ insufflation started. The pericardium was opened posterior to the phrenic nerve. The LAA was exposed by retracting the pericardial edges. The base of the appendage was measured and sized to a 40 mm epicardial clip. A 12 mm port was inserted at the 7th intercostal space. The clip was guided around the tip of the appendage and an endo-Kittner was used to gently manipulate the appendage such that all lobes were fully encircled. To ensure occlusion of the entire LAA down to the base, the cephalad face of the appendage was teased into the clip and the clip device itself rotated in a clockwise direction along the axis of the delivery device before clip closure. Real time TEE confirmed LAA exclusion without residual stump. The clip was deployed, chest tube inserted through the 12 mm port site, and the lung inflated.