Hybrid Ablation

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Dr. Bisleri, in close collaboration with the team at KHSC, is one of the few surgical specialists who perform this procedure in Canada. This hybrid procedure overcomes the drawbacks and suboptimal results of catheter ablation and minimally invasive surgical procedures, especially in the most complex and chronic scenarios, by combining the two. Hybrid ablation is a minimally invasive procedure for the treatment of persistent atrial fibrillation. Atrial fibrillation (AFib) often returns after traditional treatment and when it does, the risk of blood clots, stroke or heart failure return as well. With one hybrid procedure, doctors can ablate (destroy) targeted tissue both inside and outside the heart. Ablation blocks the dysfunctional electrical pathways that cause arrhythmia.

Compared to traditional treatment, the hybrid treatment has shown:

• Higher success in eliminating AFib.
• Better long-term results.
• Improved quality of life following the procedure.
• Lower average cost per person, at five years, versus catheter ablation or medical management alone.

Hybrid ablation combines two treatment options – catheter-based care and minimally invasive surgery – into a single hybrid procedure. Patients undergoing the procedure are only required to undergo anesthesia once and can return to their day-to-day routines sooner than with other procedures.

A patient may be a potential candidate for a hybrid procedure if they:

• Have longstanding atrial fibrillation.
• Have heart chambers that are too large for standard ablation.
• Have previously had an unsuccessful catheter ablation procedure.
• Have not been able to manage AFib with other medications or treatments.

The Hybrid Ablation Procedure

1. The patient is first put to sleep (using general anesthesia) and brought to the hybrid operating room. This room is equipped with electrophysiology equipment for sophisticated, computer-supported procedures, as well as open surgery.

2. Before and after ablation, the left atrium (upper chamber) of the heart is mapped using a specialized catheter. Voltage signals are collected from 400-500 points in the atrium. This provides the surgeon with information about how the AFib is occurring and which regions to ablate to restore function.

3. The surgeon creates a small incision in the upper abdomen in order to work laparoscopically (using small tools inserted through the incision). Voltage mapping occurs, followed by ablation of tissue on the outside of the heart. The electrophysiologist uses a catheter and 3-D mapping to ablate the regions of tissue on the inside of the heart.

4. Together, these ablations create scar tissue that blocks the damaged electrical pathways that are causing the arrhythmia (irregular heartbeat).

5. The patient remains in the hospital for two to three days after the procedure and can usually return to work in five to seven days.

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