New hope for patients and challenges for the multidisciplinary arrhythmia team: a hybrid convergent approach for atrial fibrillation treatment

BACKGROUND Available data suggest the important role of ablation of the left atrial posterior wall and epicardial myocardial layers in rhythm control therapy in patients with persistent drug-refractory atrial fibrillation (AF). However, endocardial ablation is not always effective in transmural substrate modification. The alternative treatment option is minimally invasive hybrid approach (HABL) combining the strengths of surgical and catheter ablation. AIMS This study aimed to assess the periprocedural safety as well as acute and long-term outcomes of HABL for AF. METHODS This is a retrospective single-center study of patients who underwent HABL using the minimally invasive transabdominal approach between July 2009 and January 2020. Demographic in-hospital data and 12-month follow-up results were obtained. The number of hospitalizations, cardioversions, re-ablations, and severe adverse events in a 3-year period before and after HABL were compared using data from the national healthcare provider. RESULTS In total, 158 patients (mean [SD] age, 51.02 [10.67] years) who underwent HABL were included; 61.4% had persistent AF. There was a 4.4% incidence of periprocedural complications without any fatalities. In 66% of patients, additional endocardial substrate modification was needed, in 52.6% on the posterior wall. In the 12-month follow-up, most patients (78.3%) remained free of arrhythmias. There was a significant reduction in the number of hospitalizations (for AF, 1.65 vs 0.54; or any other cause, 2.56 vs 1.31 per patient), cardioversions, and re-ablations after HABL (all P <0.05). CONCLUSIONS The hybrid multidisciplinary approach for treatment of AF is a safe and very effective treatment method in long-term follow-up, which reduces healthcare burden. It could be considered as an alternative therapeutic option especially in patients with persistent AF.