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<p>Recent updates to key international guidelines have strengthened the role of surgical interventions in the treatment of atrial fibrillation (AF) and now recommend that epicardial ablation should be considered in patients with persistent and long-standing persistent AF, either as a&#xa0;standalone thoracoscopic approach or as part of a&#xa0;hybrid epicardial-endocardial strategy. High-quality randomized trials, notably the CONVERGE, HARTCAP and CEASE-AF studies, have demonstrated that hybrid thoracoscopic ablation offers significantly greater freedom from atrial tachyarrhythmia compared with catheter-based ablation alone. In parallel, current guidelines for the first time formulate a&#xa0;clear recommendation for surgical treatment of the left atrial appendage (LAA) and support routine LAA occlusion as part of cardiac surgery to reduce the risk of thromboembolism. Taken together these developments provide a&#xa0;solid evidence base for an expanded surgical treatment concept for atrial fibrillation, including isolation of the posterior left atrial wall and targeted treatment of the LAA as a&#xa0;relevant trigger and risk region. In the light of updated guidelines, randomized data and advanced minimally invasive ablation techniques, structured, thorough atrial fibrillation treatment should now be offered as a&#xa0;standard procedure in cardiac surgery settings and understood as an integral part of the treatment portfolio.</p>

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Aktuelle Empfehlung zur endoskopischen epikardialen chirurgischen und endokardialen Ablation als Hybrid-Verfahren zur Behandlung des non paroxysmalen Vorhofflimmers

  • 期刊论文

  • 发表日期：

    2026年2月17日

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  • Nicolas Doll,
  • Jochen Pöling,
  • Antonia Doll,
  • Geza Horvath,
  • Gerold Mönnig,
  • Mahmoud Wehbe

摘要

Recent updates to key international guidelines have strengthened the role of surgical interventions in the treatment of atrial fibrillation (AF) and now recommend that epicardial ablation should be considered in patients with persistent and long-standing persistent AF, either as a standalone thoracoscopic approach or as part of a hybrid epicardial-endocardial strategy. High-quality randomized trials, notably the CONVERGE, HARTCAP and CEASE-AF studies, have demonstrated that hybrid thoracoscopic ablation offers significantly greater freedom from atrial tachyarrhythmia compared with catheter-based ablation alone. In parallel, current guidelines for the first time formulate a clear recommendation for surgical treatment of the left atrial appendage (LAA) and support routine LAA occlusion as part of cardiac surgery to reduce the risk of thromboembolism. Taken together these developments provide a solid evidence base for an expanded surgical treatment concept for atrial fibrillation, including isolation of the posterior left atrial wall and targeted treatment of the LAA as a relevant trigger and risk region. In the light of updated guidelines, randomized data and advanced minimally invasive ablation techniques, structured, thorough atrial fibrillation treatment should now be offered as a standard procedure in cardiac surgery settings and understood as an integral part of the treatment portfolio.