# Hybrid Endo-Epicardial Therapies for Advanced Atrial Fibrillation

## TL;DR

Hybrid endo-epicardial ablation therapies show better outcomes for advanced atrial fibrillation compared to traditional methods.

## Contribution

The paper highlights the effectiveness of hybrid therapies for advanced AF and the need for collaborative care teams.

## Key findings

- Endocardial ablation is less effective in advanced AF cases.
- Hybrid therapies improve long-term arrhythmia-free survival.
- Collaborative heart care teams are essential for successful hybrid treatments.

## Abstract

Atrial fibrillation (AF) is a growing health problem that increases morbidity and mortality, and in most patients progresses to more advanced diseases over time. Recent research has examined the underlying mechanisms, risk factors, and progression of AF, leading to updated AF disease classification schemes. Although endocardial catheter ablation is effective for early-stage paroxysmal AF, it consistently achieves suboptimal outcomes in patients with advanced AF. Identification of the factors that lead to the increased risk of treatment failure in advanced AF has spurred the development and adoption of hybrid ablation therapies and collaborative heart care teams that result in higher long-term arrhythmia-free survival. Patients with non-paroxysmal AF, atrial remodeling, comorbidities, or AF otherwise deemed difficult to treat may find hybrid treatment to be the most effective option. Future research of hybrid therapies in advanced AF patient populations, including those with dual diagnoses, may provide further evidence establishing the safety and efficacy of hybrid endo-epicardial ablation as a first line treatment.