Hybrid ablation for atrial fibrillation: a systematic review

Abstract

PurposeHybrid ablation for AF is performed in a growing number of centers. Due to absence of guidelines, operative approaches and perioperative care differ per center. In this review, an overview of findings from published studies on hybrid ablations is given, and related topics are discussed (e.g., one- and two-stage approaches, lesion sets, and patient management).MethodsA systematic literature search was performed in the PubMed and Embase databases. All identified articles were screened and checked for eligibility by the two authors.ResultsTwelve studies describing a total of 563 patients were selected. Due to substantial differences in approaches (one-stage, two-stage, sequential), surgical techniques (bilateral or monolateral thoracoscopy, subxiphoideal, transabdominal), energy sources (unipolar, bipolar), lesion sets (applying left or right atrial lesions), periprocedural care and endpoints (monitoring, definition of recurrence), and success rates (sinus rhythm after a mean of 26 months) are difficult to compare and varied from 27 % (without antiarrhythmic drugs, AADs) to 94 % (with AADs). For studies using bipolar devices, success rates with the use of antiarrhythmic drugs were at least 71 %. Major complications such as bleeding, sternotomy, and death occurred in 7 % of the total population (of which ten complications, 16 %, occurred in the concomitant cardiac surgery hybrid group).ConclusionThe field of AF ablation has dramatically changed over the past years, with one of the most recent developments the hybrid AF ablation. Lack of matching data hinders drawing conclusions and creating guidelines. Early results however are encouraging. More data are awaiting and needed.

Correlates of Arrhythmia Recurrence After Hybrid Epi- and Endocardial Radiofrequency Ablation for Persistent Atrial Fibrillation

“…The hybrid approach has been proposed as a technique that potentially overcomes the limitations of both endocardial-and epicardial-only ablations. 9 However, published data on the efficacy of epicardially created ablation lesions is scarce, and systematic evaluations of long-term efficacy have yet to be published. No data are available for predicting recurrence of AF after hybrid treatment.…”

Characteristics of symptomatic recurrent tachyarrhythmia after thoracoscopic ablation for persistent atrial fibrillation

“…This result raised the question of whether endocardial ablation of certain lines, including CTI, is mandatory during hybrid procedures. We suggest this question because endocardial lines are less established than epicardial lines, and additional ablations can create substrates leading to other complex arrhythmias …”

Hybrid procedures for persistent atrial fibrillation: necessity and timing of the catheter ablation stage

“…Indeed, endocardial touch-up ablations were necessary in 56% of cases according to a recent meta-analysis that included 195 patients. However, these data probably underestimate the real clinical values due to biased patient selection (11). There are multiple reasons for epicardial lesions failures, many of which have been discussed in detail elsewhere (12).…”