Introduction. Atrial fibrillation (AF) is the most frequent supraventricular arrythmia of high morbidity. Antiarrythmic drugs and percutaneous catheter ablation procedures have moderate efficacy. Aim. The aim of the study was to evaluate midterm results of totally thoracoscopic ablation for persistent and long‑standing persistent AF. Methods. 34 patients in mean age of 60 (±9.5) years underwent totally thoracoscopic ablation with left atrial appendage (LAA) occlusion. Mean duration of AF was 87 (±76) months, left atrial dimension was 45 (±9.4) mm and LVEF was 59 (±8)%. In all patients bidirectional block across ablation lines around pulmonary veins was achieved. After 3, 6, 12 and 24 months 48‑hour ECG‑Holter recordings and echocardiography were performed. Results. No mortality, stroke or TIA were observed. 97% patients were in sinus rhythm on discharge from hospital. One patient required sternotomy for effectively managed bleeding from left atrium. In 6, 12 and 24 months follow‑up, 86%, 84% and 100% of patients, respectively, remained in stable sinus rhythm. Conclusion. Totally thoracoscopic AF ablation with autonomic ganglia ablation with left atrial appendage (LAA) occlusion show high efficacy and low risk of complication in midterm follow‑up.