# In-hospital complications of hybrid vs endocardial atrial fibrillation ablation

## TL;DR

Hybrid atrial fibrillation ablation has lower major cardiovascular risks than endocardial ablation, despite higher bleeding and lung complications.

## Contribution

This study provides new evidence that hybrid AF ablation is safer in terms of major cardiovascular events compared to endocardial ablation.

## Key findings

- Hybrid ablation had a significantly lower MACE rate (3.1% vs 5.6%) compared to endocardial ablation.
- Hybrid ablation was associated with higher rates of hemorrhagic complications (12.7% vs 4.0%).
- Pulmonary complications showed a trend toward being higher in hybrid ablation (3.8% vs 1.5%).

## Abstract

Hybrid atrial fibrillation (AF) ablation has been used to achieve rhythm control in AF management. It requires both epicardial and endocardial ablation. There is limited evidence regarding the safety of this procedure.

The study aimed to compare in-hospital complication rates between hybrid AF ablation and endocardial catheter ablation (ECA) using a nationally representative dataset.

Using the National Inpatient Sample, we identified patients who underwent AF ablation between 2017 and 2022. The cohort was divided into 2 groups; those who underwent ECA and those who underwent hybrid AF ablation. The primary outcome was major adverse cardiovascular events (MACEs).

After propensity score weighting, hybrid ablation was associated with a significantly lower MACE rate (3.1% vs 5.6%, P = .0036). Rates of cardiac complications (8.8% vs 7.5%, P = .594), infections (2.7% vs 3.7%, P = .595), and length of stay (2.96 ± 0.30 vs 3.19 ± 2.45 days, P = .285) were comparable between groups. Hybrid ablation was associated with higher rates of hemorrhagic complications (12.7% vs 4.0%, P < .001), with a comparable rate of blood transfusion, whereas pulmonary complications showed a trend toward an increase (3.8% vs 1.5%, P = .099).

Hybrid AF ablation was associated with a significantly lower MACE rate compared with ECA, contrasting with earlier studies that suggested higher risk. This shift likely reflects improvements in technique and more refined patient selection. While rates of pulmonary and hemorrhagic complications were higher with hybrid ablation, transfusion needs remained similar between groups.