Hybrid Treatment of Atrial Fibrillation

Endocardial catheter ablation (CA) and surgical Maze-like procedures have become mainstays of interventional treatment for atrial fibrillation (AF). However, CA has limited efficacy particularly in patients with persistent AF who have a high risk of recurrent AF. Epicardial CA in conjunction with endocardial CA, a hybrid CA, offers the potential advantage for robust lesion formation, left atrial debulking, and mapping and CA of residual arrhythmia circuits. Hybrid CA procedures may improve the success rate of an ablation procedure for AF, particularly in those with persistent or long-standing persistent AF and those with significant structural heart disease. However, the ideal patient populations who may benefit from hybrid AF ablation and the ideal tools and techniques for hybrid AF ablation have yet to be determined. In this review, we discuss the hybrid CA procedure including motivation for and methods of hybrid CA, available tools, and reported efficacy of the procedure.