Advanced Approaches to Combined Epicardial and Endocardial Strategies – From New Consensus to Practice

Published: 14 April 2024

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    Welcome and introduction
    Hugh Calkins, Riyaz Kaba, Carlo de Asmundis, Manuela Cireddu, Claudio Tondo
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Overview

In this session, filmed at EHRA 2024 in Berlin, Germany, moderators Dr Hugh Calkins (Baltimore, US) and Prof Riyaz Kaba (London, UK) lead an international faculty comprising Prof Carlo de Asmundis (Brussels, BE), Dr Manuela Cireddu (Milan, IT) and Prof Claudio Tondo (Milan, IT) to discuss the endocardial approach to management of arrhythmias. The faculty consider which patients may benefit from the hybrid approach (particularly in light of PFA), and review what the guidelines do and don’t say about hybrid ablation.

 

Note, the live session was CME-accredited. This on-demand version is not.

 

This programme is supported by an unrestricted educational grant from AtriCure, Inc.

More from this programme

Part 1

Welcome and introduction

In this opening section, Dr Hugh Calkins provides an introduction to the topic, and notes that AF ablation is a well established commonly performed but imperfect procedure, concluding that the Converge Trial demonstrated that hybrid ablation with the convergent procedure improves outcomes, and that the trial resulted in an FDA indication for hybrid ablation for long standing persistent AF.

Part 2

The hybrid approach to the management of arrhythmias – Which patients may benefit?

Prof Carlo De Asmundis reviews patient criteria, concluding that hybrid approaches for arrhythmias are versatile, safe and effective. Furthermore, he notes that patient selection and a multidisciplinary hybrid program with EPs and surgeons are key to success.

Part 3

Has PFA changed the approach to patient selection for hybrid ablation?

Dr Manuela Cireddu notes that PFA has not yet changed the approach to patient selection for hybrid ablation, highlighting the requirement for more data on long-term outcomes and the need for validation of additional ablation beyond PV.

Part 4

Review of atrial fibrillation guidelines – What they do and don’t say about hybrid ablation

Prof Claudio Tondo reviews the literature, including the ESC and ACC Guidelines for surgical ablation of AF, and the 2024 EHRA / HRS / APHRS / LAHRS consensus statement on catheter and surgical ablation of atrial fibrillation. He suggests that future research could evaluate whether targeting extrapulmonary vein arrhythmogenic regions would enhance clinical outcomes without adding significant risk.

Part 5

Discussion – Current and future roles of hybrid ablation

Faculty Biographies

Hugh Calkins

Hugh Calkins

Professor of Medicine and Director of Electrophysiology

Dr Hugh Calkins is Professor of Medicine and Director of Electrophysiology at the Johns Hopkins Medical Institution in Baltimore, US.  

He has clinical and research interests in the treatment of cardiac arrhythmias with catheter ablation, the role of device therapy for treating ventricular arrhythmias, the evaluation and management of syncope and the study of arrhythmogenic right ventricular dysplasia. He has certifications from the American Board of Internal Medicine in Cardiovascular Disease (1989), Clinical Cardiac Electrophysiology (1992) and Internal Medicine (1986).

Dr Calkins has over 38 years of experience in the medical field. He is an Associate Editor of the Journal of Cardiovascular Electrophysiology and is on the editorial board of several prestigious publications including The Journal of the American College of Cardiology; HeartRhythm and Circulation: Arrhythmia and Electrophysiology. He is a former member of the American Board…

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Riyaz Kaba

Riyaz Kaba

Consultant Cardiologist, St George's Hospital, London, UK

Dr Riyaz Kaba is Consultant Cardiologist, St George's Hospital, London, UK. He is part of the Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute, St George’s, University of London and St George’s University Hospitals NHS Foundation Trust, London, UK; Department of Cardiology, Ashford and St Peter’s NHS Foundation Trust, Chertsey, Surrey, UK

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Carlo de Asmundis

Carlo de Asmundis

Carlo de Asmundis is a Professor in Cardiology at Vrije Universiteit Brussel, and Chair of the Heart Rhythm Management Center at Universitair Ziekenhuis Brussel, Begium. He also serves as Director of the Postgraduate Program in Cardiac Electrophysiology and Pacing at Vrije Universiteit Brussel. Prof de Asmundis graduated medical school in University Vita-Salute San Raffaele Hospital, Milan, Italy, before completing his residency in Cardiology at the Universitaʻ degli Studi di Milano. He subsequently completed his fellowship training in electrophysiology and pacing at the UZ Brussel, under the direction of Prof P Brugada.

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Manuela Cireddu

Manuela Cireddu

Dr Manuela Cireddu is an electrophysiologist in the Arrhythmia Unit and EP Laboratories at San Raffaele Hospital, MIlan, Italy. 

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Claudio Tondo

Claudio Tondo

Director

Dr Claudio Tondo is the Chairman of the Heart Rhythm centre at Centro Cardiologico, University of Milan, Italy. Dr Tondo's interests range from clinical aspects of arrhythmias to genetics.

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