Hybrid Ablation of Nonparoxysmal Atrial Fibrillation: The Convergent and Totally Thoracoscopic Approaches

Figures

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  Fig. 1.. Current standard HC lesion set (permission received from AtriCure™).

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  Fig. 2.. Epicardial Convergent Procedure Ablation (permission received from AtriCure™).

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  Fig. 3.. Completed hybrid convergent procedure: posterior wall and bilateral pulmonary vein isolation. (A) Post-1st Stage Epicardial ablation – prior endocardial Left-PVI. (B) Post-2nd Stage Endocardial ablation (Cryoballoon Right-PVI and Roof Radiofrequency ablation).

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  Fig. 4.. Left atrial appendage access via a Left VATS pericardiotomy.

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  Fig. 5.. Hybrid Totally Thoracoscopic (HTT) complete lesion set (permission granted from Eur J Cardiothoracic Surg) [22].

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  Fig. 6.. Totally thoracoscopic mobilization of the anterior pericardial reflection and division of the ligament of Marshall. (A) Ligament of Marshall (LOM) and Anterior pericardial reflection before mobilization and (B) after mobilization/ligation.

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  Fig. 7.. Intra-atrial groove mobilization from the right chest during Totally Thoracoscopic ablation. (A) Intra-atrial “groove” before mobilization, (B) after mobilization and (C) isolation with bipolar RF clamp.

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  Fig. 8.. Completion of the Hybrid TT Maze. (A) Endocardial map after 1st stage Totally Thoracoscopic ablation with complete isolation of bilateral pulmonary veins and posterior wall with (B) partial epicardial anterior mitral line and (C) endocardial anterior mitral line completion.

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  Fig. 9.. Graphical Summary of Totally Thoracoscopic Hybrid HRS Success rates.