Authors: (including presenting author): :
Ling WHI (1), Wong MKH (2), Fan KYY (1), Chan DTL (2)
Affiliation: :
(1) Cardiac Medical Unit, Grantham Hospital, (2) Department of Cardiothoracic Surgery, Queen Mary Hospital
Keyword 1: :
Atrial fibrillation
Keyword 2: :
Heart failure
Keyword 6: :
Electrophysiology
Introduction: :
Pulmonary vein isolation (PVI) using endocardial catheter ablation remains the cornerstone of AF ablation, however its efficacy diminishes in patients with persistent AF. Single-procedure success rate ranges from approximately 70–80% for paroxysmal AF to only 50-60% in persistent AF. Hybrid AF ablation is a two-stage procedure designed to treat persistent AF. The first procedure is performed with a minimally invasive epicardial approach targeting the left atrial posterior wall, vein of Marshall (VoM) and left atrial appendage (LAA) followed by a staged endocardial ablation.
Objectives: :
To study the feasibility, safety and effectiveness of this hybrid procedure for the treatment of persistent and long-standing persistent non-valvular AF in the Chinese population.
Methodology: :
Suitable patients were screened and recruited by a heart rhythm team, which consists of electrophysiologists from Grantham Hospital (GH) and cardiac surgeons from Queen Mary Hospital (QMH). Patients who fulfilled the inclusion criteria and none of the exclusion criteria were offered and consented for the procedure. In the first stage, epicardial left atrial ablation through a small subxiphoid incision, LAA closure and VoM ablation were performed via thoracoscopic approach where possible. The second stage catheter ablation was performed via groin access to complete pulmonary vein isolation and confirm satisfactory substrate modification.
Result & Outcome: :
Between March 2023 and October 2025, 36 convergent hybrid AF ablation procedures were performed in patients with a mean age of 64 ± 7 years, persistent AF duration of 11 months, and mean left atrial dimension of 4.4 cm. Epicardial ablation was successfully completed in all 36 patients, with successful LAA clip deployment achieved in 33 cases and VoM ablation performed in 25 patients. Staged endocardial ablation followed at a mean of 2.2 ± 1.9 months post-epicardial procedure. Of the cohort, 3 patients were lost to follow-up and 3 remained pending their first follow-up, leaving 30 patients with a mean follow-up duration of 18 ± 10 months. 24-hour ECG monitoring at 6 and 12 months identified AF recurrence in 8 patients. Hybrid AF ablation leverages a collaborative team approach, integrating the cross-disciplinary expertise of electrophysiologists and cardiac surgical team. It delivers a safe and effective strategy for advanced AF management, achieving freedom from AF in 73% in our cohort (22/30 patients) at a mean follow up of 18 +/- 10 months.
