Hybrid Atrial Fibrillation Ablation: A Decade-Long Single-Center Experience

Atrial fibrillation (AF) represents a major public health burden, especially in its long-standing persistent form, which is often resistant to pharmacological or catheter-based therapies. Hybrid ablation, which integrates minimally invasive surgical and endocardial catheter techniques, has been introduced to address these complex cases. However, data evaluating the long-term comparative effectiveness of immediate versus staged ablation strategies remain limited, and the specific contribution of adjunctive targets, such as Bachmann's bundle (BB), remains unclear.

In this single-center retrospective cohort study, we analyzed 60 patients with long-standing persistent AF who underwent hybrid ablation between 2008 and 2020. All patients received thoracoscopic epicardial ablation followed by endocardial catheter ablation either during the same hospitalization ("immediate group", n = 20) or ≥4 weeks later ("staged group", n = 40). A subset of patients underwent adjunctive BB ablation. The primary outcome was freedom from documented AF recurrence. Secondary outcomes included procedural complications, hospitalization duration, and long-term survival.

At a mean follow-up of 106 ± 12 months, sinus rhythm was maintained in 90.0% of patients in the immediate group and 62.5% in the staged group (p = 0.034). BB ablation was associated with significantly improved rhythm control (90% vs. 70%; p = 0.04). No major adverse events or procedural mortality were reported. The immediate group had significantly shorter hospital stays (5.6 ± 1.5 vs. 8.8 ± 1.3 days; p < 0.001). Subgroup analyses did not reveal significant differences in recurrence among patients without BB ablation.

Hybrid ablation provides durable rhythm control and excellent safety over long-term follow-up. BB ablation enhances success and should be considered in procedural planning. Immediate catheter ablation may be a viable strategy in appropriately selected patients, potentially reducing hospitalization time and healthcare resource utilization. Our findings support the need for individualized ablation strategies in complex AF management and underscore the importance of integrating adjunctive targets, such as BB, into advanced procedural workflows.