Hybrid Ablation for Patients with Persistent and Long-Standing Persistent Atrial Fibrillation.
- 1Cardiovascular Institute, North Shore University Hospital, Northwell, New Hyde Park, NY 11042, USA.
Abstract
Atrial fibrillation (AF) is the most commonly encountered arrhythmia, with a rapidly growing prevalence and significant cost to the global healthcare system. Left untreated, AF progresses over time from paroxysmal AF to persistent AF (perAF) and long-standing persistent AF (LS-perAF). AF is associated with significant mortality and morbidity by increasing the risk of developing cardiomyopathy, heart failure, dementia, stroke and systemic embolization. Endocardial catheter ablation (CA) targeting pulmonary vein isolation (PVI) alone is the most commonly employed treatment strategy for patients undergoing invasive treatment for all forms of AF. Despite technological improvements such as pulsed field ablation (PFA), procedural success rates in preventing AF recurrences in patients with perAF and LS-perAF remain suboptimal. A lack of lesion transmurality gives rise to epicardial-endocardial dissociation, which may contribute to AF recurrences. Hybrid ablation (HA) combines epicardial surgical ablation with endocardial CA. HA leads to greater freedom from AF in advanced AF compared to CA, and while existing data support the safety of HA, HA inherently is more invasive, requires a multidisciplinary approach, and has a 5-7.8% risk of major adverse events. HA is reasonable in patients with symptomatic, drug-refractory perAF or LS-perAF. Future directions include evaluating the role of novel operative technologies in HA.
Related
- Tailor‐Made Hybrid Pulsed‐Field and Radiofrequency Ablation Guided by ExTRa Mapping for Refractory Long‐Standing Persistent Atrial Fibrillation: First Experience With the Affera System Prism‐2
- The efficacy of additional atrial driver ablation in persistent and long-standing persistent atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials.
- Efficacy, safety, and strategy-modifying factors of pulsed field ablation for persistent and long-standing persistent atrial fibrillation: a systematic review and meta-analysis.
- Predictive Value of Left Atrial Strain Combined with Low-Voltage Substrate for Recurrence After Radiofrequency Catheter Ablation in Persistent Atrial Fibrillation
- Preoperative CALLY Index and Quantitative Left Atrial Low-Voltage Burden are Associated with Documented Recurrence After First Ablation for Persistent Atrial Fibrillation: A Retrospective Cohort Study.
BibTeX
@article{hsieh2026hybrid,
title = {{Hybrid Ablation for Patients with Persistent and Long-Standing Persistent Atrial Fibrillation.}},
author = {Ji-Cheng Hsieh and James K Gabriels and Kristie Coleman and Stuart Beldner and Frank Manetta and Stavros E Mountantonakis},
journal = {Journal of cardiovascular development and disease},
year = {2026},
month = oct,
doi = {10.3390/jcdd13100505},
url = {https://europepmc.org/article/MED/42930901},
note = {CC BY},
}
RIS
TY - JOUR
TI - Hybrid Ablation for Patients with Persistent and Long-Standing Persistent Atrial Fibrillation.
AU - Ji-Cheng Hsieh
AU - James K Gabriels
AU - Kristie Coleman
AU - Stuart Beldner
AU - Frank Manetta
AU - Stavros E Mountantonakis
PY - 2026
DA - 2026/10/08
JO - Journal of cardiovascular development and disease
DO - 10.3390/jcdd13100505
UR - https://europepmc.org/article/MED/42930901
AB - Atrial fibrillation (AF) is the most commonly encountered arrhythmia, with a rapidly growing prevalence and significant cost to the global healthcare system. Left untreated, AF progresses over time from paroxysmal AF to persistent AF (perAF) and long-standing persistent AF (LS-perAF). AF is associated with significant mortality and morbidity by increasing the risk of developing cardiomyopathy, heart failure, dementia, stroke and systemic embolization. Endocardial catheter ablation (CA) targeting pulmonary vein isolation (PVI) alone is the most commonly employed treatment strategy for patients undergoing invasive treatment for all forms of AF. Despite technological improvements such as pulsed field ablation (PFA), procedural success rates in preventing AF recurrences in patients with perAF and LS-perAF remain suboptimal. A lack of lesion transmurality gives rise to epicardial-endocardial dissociation, which may contribute to AF recurrences. Hybrid ablation (HA) combines epicardial surgical ablation with endocardial CA. HA leads to greater freedom from AF in advanced AF compared to CA, and while existing data support the safety of HA, HA inherently is more invasive, requires a multidisciplinary approach, and has a 5-7.8% risk of major adverse events. HA is reasonable in patients with symptomatic, drug-refractory perAF or LS-perAF. Future directions include evaluating the role of novel operative technologies in HA.
SN - 2308-3425
ER -