Approaching Atrial Fibrillation From Two Directions

The benefits of both surgical and catheter- based ablation are combined in a new hybrid procedure for preventing atrial fibrillation (AF). The procedure is designed for patients with drug-refractory symptomatic AF who are at high risk for recurrence. The hybrid approach was developed by Washington University cardiac surgeons, Ralph Damiano Jr., MD, and Hersh Maniar, MD, with electrophysiologists Phillip Cuculich, MD, and Mitchell Faddis, MD, PhD.

The procedure begins with a minimally invasive approach to the outside of the heart for the initial ablation, using several small incisions, or ports. These external lesions isolate the pulmonary veins, where atrial fibrillation often originates. After the epicardial ablation is finished, additional ablation is performed from the inside of the heart to complete the lesion set. Because both a cardiac surgeon and electrophysiologist are involved in the procedure, immediate testing of lesions can occur.

The goal of this collaborative effort is to replicate the excellent long-term success of the Cox maze IV procedure (>90 percent cure) with less risk and shorter recovery times.

Added advantages include avoiding cardio- pulmonary bypass, minimizing risk to surrounding tissues, providing more durable ablation lesions to reduce recurrences of AF, and performing left atrial appendage occlusion to reduce stroke risk.

Researchers are planning a randomized clinical trial to compare the new hybrid procedure to standard endocardial percutaneous catheter ablation in patients whose atrial fibrillation is symptomatic and persistent and whose left atrium is enlarged. Patients will be followed for 12 months post-procedure. Outside the clinical trial, the hybrid procedure is now available to any patient with atrial fibrillation after consultation with his or her doctor.