Advanced Approaches to Combined Epicardial and Endocardial Strategies – From New Consensus to Practice
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.
- Identify patient populations who may benefit from hybrid ablation
- Summarise the existing rationale and evidence for hybrid ablation beyond atrial fibrillation
- Understand how to integrate left atrial appendage exclusion in atrial ablation approaches
- Examine key aspects of new consensus recommendations for hybrid ablation
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.
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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
Manuela Cireddu
Dr Manuela Cireddu is an electrophysiologist in the Arrhythmia Unit and EP Laboratories at San Raffaele Hospital, MIlan, Italy.