hybrid AFIB ablation procedure

Posted on by Sameer Oza

Who is this procedure for:

  1. Longstanding persistent AFIB (constant AFIB >1 year in duration)
  2. Or has failed multiple catheter ablation procedures
  3. Or has a very large left atrium

Who performs this procedure – We offer this procedure at BCH in collaboration with our cardio-thoracic surgeons

  1. Cardiothoracic surgery team – Dr. Mahan and Dr. O’Hair.
  2. Electrophysiology team – Dr. Oza and Dr. Aznaurov

At BCH, we perform the hybrid ablation procedure in a staged approach – surgery followed by catheter based ablation 6-12 weeks after the surgery.

The hybrid ablation procedure aims to replicate the lesions of the Cox-Maze IV lesion set. I consider the Cox-Maze procedure the gold standard of treatment for atrial fibrillation, but it requires a sternotomy. However, the hybrid ablation procedure is performed via small incisions between the ribs in the armpit area.

Here is the hybrid ablation set :

Schematic drawing of ablation lines performed in the LA during a hybrid approach. Epicardial lines: 1, pulmonary vein isolation; 2, roof line; 3, inferior line; 4, line between the superior line and the left fibrous trigone; 5, connecting the line from the superior PV and the LAA; 6, line from the right inferior PV to the CS; 7, superior vena cava isolation; 8, intercaval line. Endocardial lines: a, mitral isthmus line; b, cavotricuspid line; *, ablation of complex fractionated atrial electrogram (CFAE). LA, left atrial; PV, pulmonary vein; LAA, LA appendage; CS, coronary sinus; MV, mitral valve.

Here is an article and editorial from Heart Rhythm Journal regarding hybrid ablation procedure:

hybrid ablationDownload
hybrid ablation editorialDownload

Here is another well written editorial from Circulation:

hybrid ablation circulationDownload

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