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Updated: May 6, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Hybrid strategies for stand-alone surgical ablation of atrial fibrillation
Fabrizio Rosati1, Massimo Baudo1, Michele D'Alonzo1
1Division of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy.
Insights
Hybrid ablation combines surgical and catheter ablation (CA) for atrial fibrillation (AF) treatment. This approach aims to improve long-term rhythm control and reduce complications compared to traditional methods.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Atrial fibrillation (AF) significantly impacts cardiac health and quality of life.
- Current treatments like antiarrhythmic drugs and catheter ablation (CA) have suboptimal long-term rhythm outcomes.
- Surgical ablation offers transmural lesions but is limited by invasiveness.
Purpose of the Study:
- To explore the rationale and effectiveness of hybrid ablation for AF treatment.
- To review different thoracoscopic strategies and their combination with CA.
- To discuss outcomes and expert opinions on hybrid ablation approaches.
Main Methods:
- Review of existing literature on hybrid ablation techniques for AF.
- Discussion of thoracoscopic strategies: Fusion, bipolar clamp, and convergent techniques.
- Analysis of combining surgical ablation with electrical mapping during CA.
Main Results:
- Hybrid ablation demonstrates excellent rhythm outcomes and low perioperative complication rates.
- The combination of surgical and catheter-based approaches enhances long-term rhythm stability.
- Minimally invasive thoracoscopic techniques are key to simplified surgical ablation.
Conclusions:
- Hybrid ablation offers a promising strategy to improve AF treatment efficacy.
- It synergizes the benefits of surgical and catheter ablation while minimizing invasiveness.
- Further research and expert consensus are valuable for optimizing hybrid ablation protocols.
Abstract:
Atrial fibrillation (AF) has been reported as a major cause of cardiac morbidity and mortality, and significantly reduces the quality of life in symptomatic patients. Current guidelines recommend antiarrhythmic drugs and catheter ablation (CA) as first-line therapy. Despite CA showed to be associated with lower incidence of peri-procedural complications, rhythm outcomes are far from optimal. Indeed, patients undergoing CA frequently require multiple AF ablation procedures, especially in those with persistent and long-standing persistent AF. While surgical ablation can provide transmural lesions, surgical invasiveness has limited the widespread use of this approach due to the increased perioperative complications. The development of minimally invasive thoracoscopic approaches has renewed the interest towards surgical ablation, thus favoring more simplified ablation sets. Therefore, the concept of "hybrid" ablation has emerged in order to theoretically enhance advantages of both minimally invasive and CA procedures while seeking to improve rhythm outcomes and reduce invasiveness and incidence of perioperative complications. On one hand, it provides the effectiveness of a surgical ablation, on the other, electrical mapping during CA can identify and treat any ablation gap or provide additional ablation lines, thus improving the chance of a stable sinus rhythm restoration at long-term follow-up. Three main thoracoscopic strategies are currently available. All of them can be performed in conjunction with the "catheter ablation procedure": the "Fusion" technique, the bipolar clamp technique, and the most recent "convergent" technique. CA can be performed either simultaneously or with a staged approach after a blanking period in order to allow the ablation lesion to stabilize. Excellent results of the hybrid procedures have been reported in terms of rhythm outcomes and incidence of perioperative complications. This narrative review aims to discuss the rationale behind the concept of hybrid ablation for the treatment of AF regarding different available strategies, results and expert opinions.
