Hybrid one-stage atrial fibrillation ablation

Area of Science:

• Cardiology
• Cardiac Surgery
• Electrophysiology

Background:

• Persistent and long-standing persistent atrial fibrillation (AF) significantly impact patient quality of life and are linked to adverse health outcomes.
• Endocardial catheter ablation (CA) monotherapy demonstrates limited efficacy in managing these complex AF types.
• Hybrid ablation strategies, integrating epicardial and endocardial approaches, show promise for improved AF treatment.

Purpose of the Study:

• To illustrate a hybrid ablation technique for persistent and long-standing persistent atrial fibrillation.
• To detail a combined epicardial and endocardial ablation strategy.
• To showcase left atrial appendage exclusion and ablation of specific atrial regions.

Main Methods:

• The described hybrid technique involves left atrial dome ablation and left atrial appendage exclusion via left thoracotomy.
• Posterior left atrial wall ablation is performed using a subxiphoid approach.
• Endocardial catheter ablation (CA) is completed during the same procedural session.

Main Results:

• The hybrid approach aims to improve upon the limited efficacy of endocardial CA alone.
• Combining epicardial and endocardial ablation, including LAA exclusion, has demonstrated enhanced outcomes in preliminary studies.
• This procedural video serves as a tutorial for a comprehensive hybrid AF ablation strategy.

Conclusions:

• Hybrid ablation, incorporating epicardial and endocardial techniques, represents an advanced strategy for treating challenging persistent atrial fibrillation.
• Left atrial appendage exclusion and targeted ablation regions are key components of this improved approach.
• This combined method offers a potential solution for patients with limited response to conventional catheter ablation.