HYBRID ATRIAL FIBRILLATION FOR ADVANCED ATRIAL FIBRILLATION



Ali Khoynezhad, M.D., Ph.D., Cedars-Sinai Medical Center, Los Angeles, CA, USA

Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with a nearly five-fold increased risk for stroke as well as over two-fold increased risk of death. For symptomatic drug-refractory AF, percutaneous ablation has been used with good success in paroxysmal AF. For patients with persistent AF, the results of catheter ablation are not very good. Surgical AF using minimal-invasive approaches may be offered to this cohort. We analyzed our data in thoracoscopically-performed ablation of AF on the beating heart, and found this to be technical feasible, achieving high success rates with low procedure-related morbidity in early follow-up.

The next frontier in treatment of atrial fibrillation is hybrid atrial fibrillation. This is the most aggressive and arguably the most effective approach in advanced AF. The patient undergoes initially a thoracoscopic Maze with complex left atrial lesion set. At three months, an EP evaluation of the left atrial lesions are performed, and additional lesion performed as needed. Furthermore, the right-sided isthmus lesion is performed. The results of the hybrid approach are discussed along with on-going DEEP trial investigating global outcome with hybrid Maze.