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Review
. 2022 Sep 8;9(9):302.
doi: 10.3390/jcdd9090302.

Hybrid Ablation of Atrial Fibrillation: A Contemporary Overview

Massimiliano Marini  1   2 , Luigi Pannone  2 , Domenico G Della Rocca  2 , Stefano Branzoli  3   4 , Antonio Bisignani  2 , Sahar Mouram  2 , Alvise Del Monte  2 , Cinzia Monaco  2 , Anaïs Gauthey  2 , Ivan Eltsov  2   4 , Ingrid Overeinder  2 , Gezim Bala  2 , Alexandre Almorad  2 , Erwin Ströker  2 , Juan Sieira  2 , Pedro Brugada  2 , Mark La Meir  4 , Gian-Battista Chierchia  2 , Carlo De Asmundis  2 , Fabrizio Guarracini  1
Affiliations
Review

Hybrid Ablation of Atrial Fibrillation: A Contemporary Overview

Massimiliano Marini et al. J Cardiovasc Dev Dis. .

Abstract

Electrical isolation of pulmonary veins (PVI) is the cornerstone of invasive treatment of atrial fibrillation (AF). However, arrhythmia-free survival of a PVI only approach is suboptimal in patients with persistent and long-term persistent AF. Hybrid AF ablation has been developed with the aim of combining the advantages of a thoracoscopic surgical ablation (direct visualization of anatomical structures to be spared and the possibility to perform epicardial lesions) and endocardial ablation (possibility to check line block, confirm PVI, and possibility to perform cavotricuspid isthmus ablation). Patient selection is of utmost importance. In persistent and long-term persistent AF, hybrid AF ablation demonstrated promising results in terms of AF free survival. It has been associated with a relatively low complication rate if performed in centers with expertise in hybrid procedures and experience with both surgical and endocardial ablation. Different techniques have been described, with different approaches and lesion sets. The aim of this review is to provide a state-of-the-art overview of hybrid AF ablation.

Keywords: atrial arrhythmias; atrial fibrillation; atrial fibrillation ablation; hybrid ablation.

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Conflict of interest statement

A.B. is consultant for Biotronik; G.C. received compensation for teaching purposes and proctoring from Medtronic, Abbott, Biotronik, Boston Scientific, Acutus Medical. M.L.M. is consultant for Atricure. C.D.A. receives research grants on behalf of the center from Biotronik, Medtronic, Abbott, LivaNova, Boston Scientific, AtriCure, Philips, and Acutus; C.D.A. received compensation for teaching purposes and proctoring from Medtronic, Abbott, Biotronik, Livanova, Boston Scientific, Atricure, Acutus Medical Daiichi Sankyo. The remaining authors have nothing to disclose.

Figures

Figure 1
Figure 1
Videothoracoscopic Surgical Techniques overview. Panel (A): clamp technique; Panel (B): fusion technique; Panel (C): convergent technique.
Figure 2
Figure 2
Hybrid AF ablation thoracoscopic access. Panel (A): left pulmonary veins isolation with the clamp (Synergy System; Atricure; West Chester, OH, USA); Panel (B): left atrial appendage closure with the clip (Atriclip, Atricure, West Chester, OH, USA); Panel (C): roof line with linear radiofrequency probe (Coolrail; Atricure, West Chester, OH, USA); Panel (D): ablation line between the clip and left pulmonary veins (yellow arrow).
Figure 3
Figure 3
Hybrid AF ablation workflow overview.
See this image and copyright information in PMC

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