Display options
Share it on

Ann Transl Med. 2021 Jun;9(11):947. doi: 10.21037/atm-21-196.

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

Annals of translational medicine

Ali Khoynezhad, Nikhil Warrier, Tiffany Worthington, Adrian Shandling

Affiliations

  1. MemorialCare Heart and Vascular Institute, Long Beach, CA, USA.

PMID: 34350262 PMCID: PMC8263859 DOI: 10.21037/atm-21-196

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 Cox-maze 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.

2021 Annals of Translational Medicine. All rights reserved.

Keywords: Atrial fibrillation; cardiac surgical procedures; electrophysiology

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at: http://dx.doi.org/10.21037/atm-21-196). AK serves as an unpaid editorial board member of Annals of Tr

References

  1. J Thorac Cardiovasc Surg. 2017 Jun;153(6):1330-1354.e1 - PubMed
  2. Int J Cardiol Heart Vasc. 2020 Jan 06;26:100459 - PubMed
  3. Circulation. 1999 Sep 14;100(11):1203-8 - PubMed
  4. Circulation. 2010 Jul 13;122(2):109-18 - PubMed
  5. Am J Cardiol. 1980 Jun;45(6):1167-81 - PubMed
  6. Neth Heart J. 2019 Mar;27(3):142-151 - PubMed
  7. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2019 Sep;163(3):233-240 - PubMed
  8. J Interv Card Electrophysiol. 2020 Sep;58(3):333-343 - PubMed
  9. N Engl J Med. 1998 Sep 3;339(10):659-66 - PubMed
  10. J Thorac Dis. 2017 Dec;9(12):4844-4848 - PubMed
  11. Circulation. 2000 Nov 21;102(21):2619-28 - PubMed
  12. Eur J Cardiothorac Surg. 2015 Oct;48(4):531-40; discussion 540-1 - PubMed
  13. Circulation. 2003 Jul 1;107(25):3176-83 - PubMed
  14. Circulation. 1999 Nov 2;100(18):1879-86 - PubMed
  15. Eur Heart J. 2019 Mar 7;40(10):820-830 - PubMed
  16. Circ Arrhythm Electrophysiol. 2017 Oct;10(10): - PubMed
  17. Ann Thorac Surg. 2008 Mar;85(3):909-14 - PubMed
  18. J Thorac Cardiovasc Surg. 2007 Feb;133(2):389-96 - PubMed
  19. Am J Cardiol. 2020 Apr 1;125(7):1054-1062 - PubMed
  20. J Thorac Cardiovasc Surg. 1991 Apr;101(4):569-83 - PubMed

Publication Types