Hybrid Treatment of Advanced Atrial Fibrillation: A Best Practice Guide for the Subxiphoid Approach-Hybrid Therapies for Treatment of Advanced AF How the Evidence Supports Epicardial Left Atrial Ablation

Hybrid Therapies for Treatment of Advanced AF How the Evidence Supports Epicardial Left Atrial Ablation

Video Transcription

Video Summary

The presentation discusses the benefits and methodologies of epicardial left atrial ablation, particularly for managing atrial fibrillation (AFib). It emphasizes the importance of early intervention in AFib cases to prevent progression. Conventional methods of pulmonary vein isolation may not suffice for patients with advanced AFib due to the structural changes and fibrosis primarily around the posterior wall of the left atrium. The presentation highlights challenges of endocardial ablation, such as intermittent connection issues and ineffectiveness in truly isolating the posterior wall. However, hybrid approaches combining epicardial surgical procedures have shown promising results. Trials like CONVERGE and CEASE-AF demonstrate the efficacy of these methods, especially for patients with persistent or long-standing AFib. The key points are achieving thorough, transmural lesion sets that endocardial approaches alone may not reliably secure and considering hybrid methodologies as a first-line treatment, providing more durable outcomes.

Keywords

epicardial ablation

atrial fibrillation

hybrid approaches

pulmonary vein isolation

CONVERGE trial