Guidelines HRS 2017. Opening the way to Hybrid ?

prof. Carlo de Asmundis MD, PhD

Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel - Universitair

Ziekenhuis Brussel, Brussels Belgium

Potential conflicts of interest

Carlo de Asmundis:

▪ I have the following potential conflicts of interest toreport: educational grants Medtronic, Abbott,Biotronik, Biosense Webster, Daichi Sankyo,Cardiotek, Livanova, Atricure, Bayer.

…Catheter ablation is the recommended treatment for symptomatic paroxysmal AF which is refractory to at least one class I or class III anti-arrhythmic drug…

- Calkins H, HRS/EHRA/ECAS Catheter and Surgical Ablation of AF, Heart Rhythm 2012

- Calkins H, HRS/EHRA/ECAS Catheter and Surgical Ablation of AF, Heart Rhythm 2017

First Time we consider the anatomy, thanks to the surgeons

Mechanisms of AF: Multiple Wavelet Hypothesis, Reentry, Spiral Waves, Rotational Activity, and Focal Triggers from the Pulmon

ablation induced

The Mechanisms of AF Recurrence After Catheter Ablation or Surgical AF Ablation

28 endpoint only 1 I A

Taken together, thoracoscopic surgery is a promising tool

for the treatment of persistent AF.

What that does take to succeed is the collaboration of

surgeons and electrophysiologists, which is consistent with

the philosophy of working in heart teams. Which patients

with persistent AF are the best candidates for thoracoscopic

surgery remains unresolved for this moment.