Hybrid ablation for atrial fibrillation: a systematic review.
OBJECTIVE
Hybrid ablation for AF is performed in a growing number of centers. Due to absence of guidelines, operative approaches and perioperative care differ per center. In this review, an overview of findings from published studies on hybrid ablations is given, and related topics are discussed (e.g., one- and two-stage approaches, lesion sets, and patient management).


METHODS
A systematic literature search was performed in the PubMed and Embase databases. All identified articles were screened and checked for eligibility by the two authors.


RESULTS
Twelve studies describing a total of 563 patients were selected. Due to substantial differences in approaches (one-stage, two-stage, sequential), surgical techniques (bilateral or monolateral thoracoscopy, subxiphoideal, transabdominal), energy sources (unipolar, bipolar), lesion sets (applying left or right atrial lesions), periprocedural care and endpoints (monitoring, definition of recurrence), and success rates (sinus rhythm after a mean of 26 months) are difficult to compare and varied from 27 % (without antiarrhythmic drugs, AADs) to 94 % (with AADs). For studies using bipolar devices, success rates with the use of antiarrhythmic drugs were at least 71 %. Major complications such as bleeding, sternotomy, and death occurred in 7 % of the total population (of which ten complications, 16 %, occurred in the concomitant cardiac surgery hybrid group).


CONCLUSIONS
The field of AF ablation has dramatically changed over the past years, with one of the most recent developments the hybrid AF ablation. Lack of matching data hinders drawing conclusions and creating guidelines. Early results however are encouraging. More data are awaiting and needed.
Department of Cardiology, Maastricht University Medical Center, PO Box 5800, Maastricht, The Netherlands. mindyvroomen1@gmail.com.|Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands. mindyvroomen1@gmail.com.
Mindy
http://orcid.org/0000-0003-3473-9076
M
Vroomen
Department of Cardiology, Maastricht University Medical Center, PO Box 5800, Maastricht, The Netherlands.|Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
Laurent
L
Pison
D055011:Ablation Techniques / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000401:mortality* / Q000601:surgery*; D013504:Cardiovascular Surgical Procedures / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data; D015984:Causality; D003131:Combined Modality Therapy / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D012307:Risk Factors; D015996:Survival Rate
Atrial fibrillation; Endocardial-epicardial ablation; Hybrid ablation; Review