The Present and Future
JACC Review Topic of the Week
Combined Minimally Invasive Surgical and Percutaneous Catheter Ablation of Atrial Fibrillation: JACC Review Topic of the Week

https://doi.org/10.1016/j.jacc.2022.11.039Get rights and content
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open access

Highlights

  • Hybrid epicardial surgical/endocardial catheter-based techniques achieve transmural ablation of arrhythmias.

  • The risks of hybrid ablation for AF have been 2.0-fold to 3.6-fold higher than catheter-based ablation.

  • There is a paucity of data from randomized trials comparing hybrid to catheter-based ablation.

  • Further research is needed to define the role of hybrid ablation in management of patients with AF.

Abstract

Hybrid ablation is a novel therapy in the invasive management of patients with atrial fibrillation (AF) which combines minimally invasive surgical and percutaneous catheter-based techniques. The evidence is mainly based on observational studies from experienced centers, with success rates of approximately 70% and risks that are 2.0-fold to 3.6-fold higher than catheter-based ablation. Hybrid ablation is offered typically to patients with persistent or longstanding persistent AF which, by design, requires 2 procedures (epicardial surgical and endocardial catheter-based ablation). One randomized trial demonstrated that hybrid ablation was more effective than catheter-based ablation, but with higher complication rates. The incidence of the most serious complications has decreased in contemporary studies of hybrid ablation. At present, hybrid ablation should be performed by experienced centers on selected patients with persistent or longstanding persistent AF. Additional randomized trials are needed to define the risks, benefits, and cost effectiveness of hybrid ablation to identify its most appropriate application in clinical practice.

Key Words

atrial fibrillation
cardiac surgery
hybrid ablation

Abbreviations and Acronyms

AF
atrial fibrillation
PVI
pulmonary vein isolation

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Listen to this manuscript's audio summary by Editor-in-Chief Dr Valentin Fuster on www.jacc.org/journal/jacc.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.

Drs Bisleri and Ha served as co-primary authors on this paper.