Hybrid Ablation Procedures of Atrial Fibrillation —How to Optimize Patient Selection and Improve the Procedural Approach

AbstractPurpose of ReviewTraditional surgical ablation and endocardial catheter ablation have historically been the primary ablation approaches for treating atrial fibrillation (AF) concomitantly with another surgical procedure or as a standalone procedure, respectively. In the last several years, hybrid epicardial-endocardial ablation utilizing a subxiphoid approach for epicardial left atrial ablation combined with endocardial catheter ablation (converge procedure) has been an emerging hybrid approach to standalone AF catheter ablation. The procedure was developed as a treatment option for patients with advanced AF in which traditional catheter ablation had limited efficacy and relief. The technique combines the benefits of both endocardial and epicardial ablation in a minimally invasive manner to provide a comprehensive lesion set characterized by durable transmural lesions. The Convergent technique involves a minimally invasive surgical addition to standard endocardial ablation. Identifying appropriate patients for this approach and optimizing procedural details will assist clinicians in decision-making. In this review we discuss optimization of patient selection for the convergent procedure and tools and techniques to maximize workflow and clinical outcomes.Recent FindingsThe dual epicardial-endocardial nature of hybrid may be in part why the hybrid convergent procedure has been successful in treating even longstanding persistent AF (LSPAF), which was previously thought t...
Source: Current Cardiovascular Risk Reports - Category: Cardiology Source Type: research