Why the study?
Catheter ablation results remain controversial in long-standing persistent AF where extrapulmonary foci contribute, prompting evaluation of hybrid epicardial and endocardial approaches.
Does hybrid ablation with left atrial appendage exclusion improve outcomes in patients with long-standing persistent atrial fibrillation?
Does hybrid ablation with left atrial appendage exclusion improve outcomes in patients with long-standing persistent atrial fibrillation?
This review discusses the evidence for hybrid ablation combining epicardial and endocardial approaches with LAA exclusion for managing long-standing persistent atrial fibrillation.
May support hybrid ablation in select long-standing persistent AF cases; leaves open need for randomized data before practice change.
The treatment of AF has evolved over the past decade with increasing use of catheter ablation in patients refractory to medical therapy. While pulmonary vein isolation using endocardial catheter ablation has been successful in paroxysmal AF, the results have been more controversial in patients with long-standing persistent AF where extrapulmonary venous foci are increasingly recognised in the initiation and maintenance of AF. Hybrid ablation is the integration of minimally invasive epicardial ablation with endocardial catheter ablation, and has been increasingly used in this population with better results. The aim of this article was to analyse and discuss the evidence for the integration of catheter and minimally invasive surgical approaches to treat AF with specific focus on convergent ablation and exclusion of the left atrial appendage using a surgically applied clip.
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Wats et al. (2020) studied this question.
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