Hybrid Epicardial-Endocardial Approach to Atrial Fibrillation Ablation

  • Khola Tahir
  • Andy Kiser
  • Thomas Caranasos
  • J. Paul Mounsey
  • Anil Gehi
Arrhythmia (G Upadhyay, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Arrhythmia


Who should undergo hybrid AF ablation?

Patients with symptomatic persistent or long-standing persistent atrial fibrillation refractory to pharmacological or routine catheter ablation can be considered for hybrid epicardial-endocardial AF ablation. Although it seems clear that patient selection should be important when considering hybrid AF ablation for optimal results, unfortunately, available data on the outcomes of hybrid epicardial-endocardial ablation is limited. Hybrid ablation is rarely compared to stand-alone catheter ablation, the surgical approach (access site, lesion set, ablation tool) is inconsistent, and the patient population studied is often suitable for a catheter ablation approach (paroxysmal AF, minimal structural heart disease). We believe that the hybrid approach should be considered in patients who either have had unsuccessful catheter ablations or have significant structural heart disease evident by enlarged left atrial size or atrial fibrosis. These are the patients who warrant the added risk of a hybrid approach and who stand to benefit from a more extensive ablation including isolation of the posterior wall of the left atrium. Multi-center studies with a uniform hybrid ablation approach and comparison with a stand-alone catheter ablation approach are needed to help clarify the role of hybrid AF ablation.


Hybrid AF ablation Epicardial-endocardial ablation Arrhythmia 


Compliance with Ethical Standards

Conflict of Interest

Khola Tahir and Thomas Caranasos each declare no potential conflicts of interest. Andy Kiser is a consultant for Atricure, Inc. J. Paul Mounsey is a consultant for Atricure, Inc., Boston Scientific, and Medtronic. Anil Gehi reports research funding from Bristol-Myers Squibb Foundation and speaker’s honoraria from Zoll Inc. and Abbott Inc.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Papers of particular interest, published recently, have been highlighted as: • Of importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Khola Tahir
    • 1
  • Andy Kiser
    • 2
  • Thomas Caranasos
    • 3
  • J. Paul Mounsey
    • 4
  • Anil Gehi
    • 1
  1. 1.Division of Cardiology, Department of MedicineUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Division of Cardiac SurgeryEast Carolina Heart InstituteGreenvilleUSA
  3. 3.Division of Cardiothoracic Surgery, Department of SurgeryUniversity of North CarolinaChapel HillUSA
  4. 4.Division of CardiologyEast Carolina Heart InstituteGreenvilleUSA

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