A narrative review of hybrid ablation for persistent and longstanding persistent atrial fibrillation

Atrial fibrillation is the most common sustained arrhythmia and is characterized by rapid and irregular atrial activation with loss of atrial contraction. There has been a significant evolution of treatments over the past 30 years. Initially, cardiac surgeons developed approaches via sternotomy with superior efficacy, however early iterations of the procedure were associated with prolonged recovery time and frequent need for pacemaker placement. The current surgical approach to the maze procedure via sternotomy yields excellent efficacy and is a Class 1 recommendation for patients with atrial fibrillation undergoing a concomitant procedure. Several years following the initial development of the surgical maze procedure, cardiac electrophysiologists developed less invasive, however less efficacious catheter ablation options by percutaneous approach. Both the surgical and transcatheter approaches have their advantages and disadvantages with varying risks of complications and efficacy. Through the combination of expertise of cardiac surgeons paired with the electrophysiology team, a hybrid ablation procedure has been developed offering an increased efficacy with a less-invasive approach than the current gold standard treatment of Cox-maze IV procedure. This review will discuss the hybrid ablation procedure, review recent associated clinical trials, and discuss advantages and challenges associated with this multidisciplinary approach for management of patients with AF.