Hybrid Procedure (Endo/Epicardial) versus Standard Manual Ablation in Patients Undergoing Ablation of Longstanding Persistent Atrial Fibrillation: Results from a Single Center

Zachary Edgerton, Alessandro Paoletti Perini, Rodney Horton, Chintan Trivedi, Pasquale Santangeli, Rong Bai, Carola Gianni, Sanghamitra Mohanty, J. David Burkhardt, G. Joseph Gallinghouse, Javier E. Sanchez, Shane Bailey, Maegen Lane, Luigi Di Biase, Francesco Santoro, Justin Price, Andrea Natale

Research output: Contribution to journalArticlepeer-review

51 Scopus citations


Hybrid versus Endocardial Ablation for LSPAF Introduction Ablation of longstanding persistent atrial fibrillation (LSPAF) is the most challenging procedure in the treatment of AF, either by surgical or by percutaneous approach. Objective We investigated the difference in success and complication rates between combined surgical epicardial and endocardial catheter ablation procedure and our standard endocardial ablation procedure. Methods and Results Twenty-four consecutive patients (group 1) with LSPAF and enlarged left atrium (>4.5 cm) underwent a combined procedure, consisting of surgical, closed-chest, epicardial, radiofrequency ablation (nContact, NC, USA) via pericardial access, and concomitant endocardial ablation (hybrid procedure). Procedural complications and long-term outcomes were compared to those of 35 consecutive patients who refused the hybrid procedure and underwent standard endocardial only ablation (group 2). Baseline characteristics were comparable. In group 1, 1 patient (4.2%) developed post-procedural cardio-embolic stroke and 3 (12.5%) died (1 atrio-esophageal fistula, 1 fatal stroke, 1 of unknown cause in early follow-up), while no strokes or deaths occurred in group 2. Overall complication rates were higher for group 1 (P = 0.036). At 24-month follow-up, 4 (19%) patients in group 1 and 19 (54.3%) in group 2 were arrhythmia-free after a single procedure, on or off antiarrhythmic drugs (P<0.001). Total procedural time (276.9 ± 63.5 vs. 203.15 ± 67.3 minutes) and length of hospital stay (5 [IQR 3-8] vs. 1 [IQR 1-3] days were significantly shorter for group 2 (P <0.001). Conclusions In patients with LSPAF and enlarged left atrium, a concomitant combined surgical/endocardial ablation approach increases complication rate and does not improve outcomes when compared to extensive endocardial ablation only.

Original languageEnglish (US)
Pages (from-to)524-530
Number of pages7
JournalJournal of cardiovascular electrophysiology
Issue number5
StatePublished - May 1 2016


  • atrial fibrillation
  • catheter ablation
  • endocardial approach
  • hybrid procedure
  • longstanding persistent atrial fibrillation
  • surgery
  • unipolar surgical ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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