Hybrid Ablation: A New Standard of Care in Long Standing Persistent Atrial Fibrillation?

Published: 08 April 2022

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The cornerstone of AF is electrical isolation of the pulmonary veins (PV). In patients with non-paroxysmal AF, PV isolation alone is insufficient, and one needs to modify the atrial arrhythmogenic substrate. AF ablation is now a common procedure and mostly performed using a transvenous, endocardial approach with catheters. For patients with persistent AF however, this procedure is not sufficient.

There is a growing movement towards a convergent procedure management strategy, used alongside standard catheterisation techniques to optimise patient outcomes. More and more research suggests that an integrated approach involving multidisciplinary teams (of electrophysiologists and surgeons) may lead to improved success rates and increased patient satisfaction.


This programme, first presented at EHRA 2022, brings together thought-leaders from across Europe to discuss the role of hybrid ablation in treating long-standing persistent AF. Moderator, Prof John Camm (St George’s University of London, UK) leads the faculty to explore the need for the hybrid approach, the science supporting its implementation and insights from experienced practitioners.


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

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

Learning Objectives

  • Describe the fundamental steps in hybrid ablation
  • Recall the clinical outcomes from randomised controlled trials and real-world data supporting the use of hybrid ablation in persistent AF
  • Select ideal patient candidates for hybrid ablation
  • Consider the existing equipment and skill requirements for successful hybrid ablation


  • Electrophysiologists
  • General cardiologists
  • Allied health professionals engaged in the treatment of persistent AF

More from this programme

Part 1


Prof John Camm reviews the aims of the session, and sets the scene.

Part 2

Why Hybrid Ablation?

Prof Jaswinder Gill considers the advantages of a hybrid approach over standard catheter ablation, including a review of the clinical evidence. In addition, the reproducibility and consistency of the hybrid approach are explored.

Part 3

The Hybrid Convergent Procedure Explained

Dr Yuri Blaauw provides an overview of how the convergent approach differs from other hybrid approaches, as well as delivering an illustrative overview of the procedure. He asks how the surgical element influences success.

Part 4

Building a Standard of Care: Insight From an Experienced Operator

Prof Claudio Tondo provides an update on the number of centres operating convergent programmes within the US and Europe, and discusses practical considerations for adopting the convergent procedure, including patient selection, training, equipment and required skillsets.

Part 5

Key Considerations for Electrophysiologists, and Close

Prof John Camm moderates a panel discussion, addressing considerations around safety, single and dual-stage procedure, in addition to adoption rates in Europe and the US, and guideline implications.

Faculty Biographies

A John Camm

A John Camm

Professor of Clinical Cardiology

John Camm is British Heart Foundation Professor of Clinical Cardiology (Emeritus) at St George’s University of London, London, UK. His interests include cardiac arrhythmias, atrial fibrillation, stroke prevention, and anticoagulation.

Prof Camm is Editor of the European Society of Cardiology Textbook of Cardiovascular Medicine and ESC CardioMed, Electrophysiology of the Heart, Clinical Cardiology and Evidence Based Cardiology.  He has written or edited more than 40 books, predominantly in the field of cardiac arrhythmology. He has authored or co-authored more than 1450 peer reviewed papers, more than 500 book chapters, and in excess of 2500 accepted abstracts.  He has delivered more than 1000 international lectures.

Prof Camm has been involved in the production of numerous guidelines, including the ESC guidelines for the management of atrial fibrillation.

Prof Camm is a member of the Arrhythmia …

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Yuri Blaauw

Yuri Blaauw

University Medical Center Groningen, Groningen, The Netherlands

Dr Yuri Blaauw is an Electrophysiologist at the University Medical Center Groningen, Groningen, The Netherlands.

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Jaswinder Gill

Jaswinder Gill

Consultant Cardiologist

Dr Jaswinder Singh Gill qualified from Cambridge University in 1979 and was appointed Consultant Cardiologist to Guy’s & St Thomas’ NHS Trust in 1995. 

Dr Gill has set up the electrophysiology unit and arrhythmia services for Guy’s & St Thomas’ NHS Trust. His special interests are in the treatment of arrhythmias including radio frequency ablation and the implantation of pacemakers and defibrillators. 

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Claudio Tondo

Claudio Tondo


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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