Embracing New Approaches in Long-Standing Persistent Atrial Fibrillation

Published: 04 August 2022

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  • episode_image
    3m 59s
    Part 1 Welcome and Introductions Andrea Russo, Hugh Calkins, David DeLurgio, Rukshen Weerasooriya, Pragnesh Joshi, Emily Kotschet, Adrian Pick
  • episode_image
    12m 32s
    Part 4 Panel Discussion Andrea Russo, Hugh Calkins, Adrian Pick, Emily Kotschet, David DeLurgio, Rukshen Weerasooriya, Pragnesh Joshi
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This on-demand version of the live broadcast aims to highlight the benefits of a hybrid management approach for minimally invasive procedures.

In non-paroxysmal atrial fibrillation (AF), where modification of the atrial arrhythmogenic substrate is required, catheter-based ablation using a transvenous, endocardial approach is commonly used but there is growing evidence for a hybrid approach to improve patient outcomes. Research suggests that an integrated approach involving both electrophysiologists and surgeons can lead to improved success rates and increased patient satisfaction compared with a catheter-only approach.


Whilst relatively new, hybrid AF ablation counts some of the world’s leading surgeons and electrophysiologists amongst its advocates. This expert-led broadcast is aimed at increasing awareness of the approach and helping physicians to adopt it in their daily practice, thanks to a series of practically-focussed presentations and discussions from some of the world’s leading experts.


Note, the live version of this session was CME accredited; this on-demand version is not.

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

Key Learning Objectives

  • Define the key team members essential for the adoption of the convergent procedure
  • Recall the scientific evidence supporting the safety and efficacy of hybrid ablation techniques in persistent AF
  • Identify clinical and anatomical features that make patients good candidates for whom the convergent procedure
  • Describe the role of electrophysiologist and surgeon in hybrid approaches
  • Compare the overall approach to hybrid ablation with other approaches such as Mini Maze
  • Identify local barriers preventing the uptake of hybrid ablation approaches

Target Audience

  • Electrophysiologists (EPs)
  • Cardiothoracic Surgeons
  • Interventional and General Cardiologists
  • Other referrers to EPs

More from this programme

Part 1

Welcome and Introductions

Dr Calkins and Dr Russo introduce the faculty and the agenda for the programme.

Part 2

Catheter, Surgical, and Hybrid AF Ablation: How Did We Get Here?

In this first session, Dr Calkins presents on the journey to treat hybrid ablation effectively using different techniques.

Part 3

The Data Behind Hybrid Ablation

Dr DeLurgio provides an overview of the data from the CONVERGE trial.

Part 4

Panel Discussion

The panel wrap up the first part of this broadcast and discuss patient selection for hybrid ablation and practical considerations when adopting a hybrid ablation approach.

Part 5

Adopting a Hybrid Approach

Prof Weerasooriya and Mr Joshi share their experience with case based examples from their practice in Perth, and discuss practical considerations for adopting the convergent procedure.

Part 6

Minimally Invasive Approaches for Long-Standing Persistent Atrial Fibrillation: Building a Successful Practice

In this final session, Dr Kotschet and Mr Pick share their experience from Melbourne. They discuss patient selection and how to build a successful team from an EPs perspective.

Part 7

The Future of Hybrid Surgical Ablation: Panel Discussion

The panel wrap up by discussing audience poll results and the future of hybrid surgical ablation.

Faculty Biographies

Emily Kotschet

Emily Kotschet

Cardiologist and Electrophysiologist

Dr Emily Kotschet is a Cardiologist and Electrophysiologist with a particular interest in inherited cardiac arrhythmias, including cardiac genetics and atrial fibrillation (AF). She works at Holmesglen Private Hospital, Cabrini Hospital in Malvern, Mulgrave Private Hospital and St John of God, Berwick, where she implants devices and performs ablation for arrhythmias. She also provides cardiac services in rural Victoria visiting Alexandra and Morwell.

Dr Kotschet completed her cardiology training at the Alfred and Monash Heart, then completed a three year fellowship in Electrophysiology with 2 years in Canada. She returned to Monash Heart, and established the AF ablation program, including Australia’s first nurse led AF clinic, as well as the…

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Adrian  Pick

Adrian Pick

Cardiothoracic Surgeon

Mr Adrian Pick graduated in 1993, from the Melbourne University Medical School then completed overseas fellowships at the MAYO clinic and the Toronto General Hospital. His interests include minimal access surgery for thoracic and cardiac surgery with emphasis on mitral valve repair and limited access aortic valve replacement. He is also committed to maximizing surgical treatment for both concomitant (often in conjunction with mitral or aortic valve procedures) and lone atrial fibrillation.

More recently he has embraced the transition to Hybrid surgery. He favours the Totally thoracoscopic maze for patients with persistent Atrial fibrillation who have symptoms, have failed catheter ablation or are intolerant to antiarrhythmic drugs or anticoagulants.

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