What does this research mean for the field?

Immediate hybrid ablation maintains sinus rhythm in 90% of patients with long-standing persistent atrial fibrillation, compared to 62.5% in the staged group, with adjunctive Bachmann's bundle ablation enhancing rhythm control (90% vs. 70%). Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

This research aims to evaluate the long-term outcomes of hybrid ablation strategies for long-standing persistent atrial fibrillation.

January 10, 2026Reviews in Cardiovascular Medicine1 citationsOpen Access

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

GNGiuseppe null NassoVilla Maria Hospital WVWalter null Vignaroli CDCosimo Domenico null DicandiaSanta Maria Nuova Hospital

Key Result

Immediate hybrid ablation maintained sinus rhythm in 90% of patients compared to 62.5% in the staged group, with BB ablation enhancing rhythm control (90% vs. 70%).

Key Points

This research aims to evaluate the long-term outcomes of hybrid ablation strategies for long-standing persistent atrial fibrillation.
Single-center retrospective cohort analysis of 60 patients with long-standing persistent AF.
Patients underwent thoracoscopic epicardial ablation followed by catheter ablation either immediately or staged.
Some patients received adjunctive ablative treatment targeting Bachmann's bundle.
90% of patients in the immediate group maintained sinus rhythm compared to 62.5% in the staged group (p = 0.034).
Bachmann's bundle ablation improved rhythm control (90% vs. 70%; p = 0.04).
Immediate group had shorter hospital stays (5.6 days vs. 8.8 days; p < 0.001).
No major adverse events or procedural mortality were reported.

Structured PICO

Does immediate versus staged endocardial catheter ablation following thoracoscopic epicardial ablation improve freedom from arrhythmia recurrence in patients with long-standing persistent atrial fibrillation?

Population

60 adults (aged 18-70 years) with long-standing persistent atrial fibrillation (>12 months), mean age 42 ± 13 years, 71.6% male, treated at a single center in Italy. Key inclusion: failure of ≥1 class I/III antiarrhythmic drug, no prior catheter or surgical AF ablation. Key exclusion: significant structural heart disease requiring concomitant surgery, left atrial thrombus, contraindication to anticoagulation, or left atrial diameter >65 mm.

Intervention

Immediate hybrid ablation: minimally invasive thoracoscopic epicardial ablation followed by endocardial catheter ablation during the same hospitalization (mean 6.1 ± 1.2 days post-surgery). A subset (16/20) received adjunctive Bachmann's bundle (BB) ablation.

Comparator

Staged hybrid ablation: minimally invasive thoracoscopic epicardial ablation followed by endocardial catheter ablation scheduled at least 4 weeks later (median 42 days). A subset (14/40) received adjunctive Bachmann's bundle (BB) ablation.

Outcome

Freedom from documented atrial arrhythmia recurrence (any documented episode of AF, atrial flutter, or atrial tachycardia lasting >30 seconds after a blanking period of 3 months post-procedure) at final follow-up.composite

In patients with long-standing persistent AF, hybrid ablation provides durable long-term rhythm control, with immediate catheter ablation reducing hospital stay and adjunctive Bachmann's bundle ablation significantly improving success rates.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

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