Hybrid ablation is used in patients who have persistent atrial fibrillation with dilated left atria (the chamber of the heart in which AF usually occurs).
This procedure may also be suitable for patients who have had unsuccessful treatment for their persistent AF, such as catheter ablations or failed DC cardioversions, in the past.
There are two parts to a hybrid ablation procedure: the surgical portion (convergent and left VATS left atrial appendage occlusion), which is carried out by a cardiac surgeon, and the ablation portion (endocardial AF ablation), which is carried out by a cardiologist.
Convergent and left atrial appendage management
The first part of the procedure uses video-assisted surgery (VAS). A small incision is made just below the breastbone, so that a pericardioscope (a video-guided surgical device) can be inserted and your surgeon can see and access the outside of your heart. Your surgeon will then use radiofrequency ablation to destroy any heart tissues causing your AF.
During your procedure, the surgeon will also fit something known as left-atrial appendage occlusion device. This device may reduce your chance of having a stroke by up to 90% and can sometimes be an alternative to oral anti-coagulant medication.
Using VATS (video-assisted thoracoscopy surgery), your surgeon will create three small incisions on the left-hand side of chest, so that they can access a part of the heart called the left-atrial appendage. The left-atrial appendage is then closed off with a special clip so that appendage no longer receives blood. This prevents blood clots from forming and reduces your chance of having a stroke.
Endocardial AF ablation
The second part of the procedure is performed a couple of weeks after the first procedure and involves catheter ablation inside the heart. Long, thin tubes (catheters) are inserted into the body through the groin, before being guided into place inside the heart. Your cardiologist then uses either heating (radiofrequency ablation), freezing (cryoablation) or other forms of energy to destroy the abnormal tissues inside the heart.
Following each procedure, you will usually stay in the hospital for one to two nights. After that, you’ll need to avoid any strenuous activity for two to three weeks.
You will continue to have regular follow-ups with your consultants to monitor your progress.
