Hybrid Surgical and Catheter Ablation for Atrial Fibrillation: A Systematic Review of Long-Term Outcomes

Giulio Tessitore*, Corrado Cavozza, Luca De donno, Giulia Maj and Andrea Audo

Azienda Ospedaliera santi Antonio e Biagio e Cesare Arrigo via Venezia 16 15121 Alessandria, Italy

^*Correspondance to: Giulio Tessitore 

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Abstract:

Background: Persistent and long-standing persistent atrial fibrillation (AF) remain significant therapeutic challenges despite advances in catheter-based ablation techniques. Hybrid ablation, which combines thoracoscopic epicardial ablation with endocardial catheter mapping and ablation, has emerged as a promising strategy to enhance arrhythmia control in complex cases [1,2]. Objective: To systematically review long-term outcomes of hybrid ablation in patients with persistent and long-standing persistent AF and to compare its efficacy and safety profile with conventional catheter ablation alone. Methods: A systematic search of PubMed, EMBASE, and Cochrane databases was conducted up to November 2024. Eligible studies included randomized controlled trials, prospective and retrospective cohort studies, and meta-analyses reporting outcomes in hybrid vs. catheter ablation for persistent or long-standing persistent AF. Primary endpoints included maintenance of sinus rhythm and freedom from antiarrhythmic drugs (AADs); secondary endpoints included procedural complications and mortality. Results: Thirty studies involving over 1,500 patients were included. Sinus rhythm maintenance after hybrid ablation ranged from 70.7% to 89% off AADs at long-term follow-up (mean 19 months), significantly higher than catheter ablation alone (41–49.9%) [3–8]. Complication rates were slightly higher in the hybrid group (6.5%), primarily due to bleeding and pericardial effusion, but serious adverse events and mortality remained low. Notably, complication rates declined significantly over time with increasing surgical experience [5,7,9]. Conclusions: Hybrid ablation offers superior rhythm control in persistent and long-standing persistent AF with an acceptable safety profile. Ongoing randomized trials and standardized procedural protocols are essential to optimize patient selection and procedural efficacy.

Keywords:

Atrial fibrillation

Cite the Article:

Tessitore G, Cavozza C, De donno L, Maj G, Audo A. Hybrid Surgical and Catheter Ablation for Atrial Fibrillation: A Systematic Review of Long-Term Outcomes. Ann Clin Case Rep. 2025; 10: 2751..