A narrative review of hybrid ablation for persistent and longstanding persistent atrial fibrillation

Abstract

Atrial fibrillation is the most common sustained arrhythmia and is characterized by rapid and irregular atrial activation with loss of atrial contraction. There has been a significant evolution of treatments over the past 30 years. Initially, cardiac surgeons developed approaches via sternotomy with superior efficacy, however early iterations of the procedure were associated with prolonged recovery time and frequent need for pacemaker placement. The current surgical approach to the maze procedure via sternotomy yields excellent efficacy and is a Class 1 recommendation for patients with atrial fibrillation undergoing a concomitant procedure. Several years following the initial development of the surgical maze procedure, cardiac electrophysiologists developed less invasive, however less efficacious catheter ablation options by percutaneous approach. Both the surgical and transcatheter approaches have their advantages and disadvantages with varying risks of complications and efficacy. Through the combination of expertise of cardiac surgeons paired with the electrophysiology team, a hybrid ablation procedure has been developed offering an increased efficacy with a less-invasive approach than the current gold standard treatment of Coxmaze IV procedure. This review will discuss the hybrid ablation procedure, review recent associated clinical trials, and discuss advantages and challenges associated with this multidisciplinary approach for management of patients with AF.

Atrial fibrillation: Primary prevention, secondary prevention, and prevention of thromboembolic complications: Part 2

“…For persistent and longstanding persistent AF (>1 year), the recommendations are IIa, and IIb respectively. For persistent or long-standing persistent AF, posterior wall isolation and ablation of non PV triggers also has a Class IIb recommendation (92).…”

“…As noted above, hybrid ablation studies have plagued by lack of uniformity in approaches, lesion sets, catheter ablation timing relative to the surgical approach, and follow-up protocols (92).…”

“…In addition to DEEP, 7 other hybrid ablation studies are underway in Europe and Asia. It is hoped that these ongoing clinical trials will lead to standardization of hybrid protocols with respect to lesions sets, catheter ablation timing in relationship to surgery as well as follow up protocols (92).…”

Radiofrequency ablation for treatment of atrial fibrillation with the use of intracardiac echocardiography versus without intracardiac echocardiography: A meta‐analysis of observational and randomized studies

“…[3][4][5] Over the past 30 years, there has been an exponential growth in the clinical treatment of AF including drug treatment (anticoagulation, heart rate control, and rhythm control), cardioversion, cardiac ablation, and other interventional procedures. 1,6,7 In accordance with the guideline of the National Institute for Health and Care Excellence (NICE), radiofrequency (RF) ablation is suitable for symptomatic paroxysmal or persistent AF patients if drug treatment is unsuccessful, unsuitable, or intolerable. 8 With the rapid increase of AF ablation procedures in recent years, the operators meet some challenges such as transseptal puncture, anatomic variation of pulmonary veins, and risk of esophageal injury.…”

“…AF prevalence increases with age and it is reported that the lifetime risk of AF is about 37% after 55 years old 3–5 . Over the past 30 years, there has been an exponential growth in the clinical treatment of AF including drug treatment (anticoagulation, heart rate control, and rhythm control), cardioversion, cardiac ablation, and other interventional procedures 1,6,7 . In accordance with the guideline of the National Institute for Health and Care Excellence (NICE), radiofrequency (RF) ablation is suitable for symptomatic paroxysmal or persistent AF patients if drug treatment is unsuccessful, unsuitable, or intolerable 8…”