A device recently approved by the U.S. Food & Drug Administration for the treatment of long-standing persistent atrial fibrillation (A-fib) is changing the way heart specialists can care for patients with A-fib. A-fib is a potentially serious heart rhythm irregularity that raises the risk of stroke and heart failure.

Heart specialists at Norton Heart & Vascular Institute were the first in the area to perform a Hybrid A-fib ablation in 2017. Norton Heart & Vascular Institute is also recognized as a top 10 site in the nation for this type of procedure. Since 2017 the Norton Heart & Vascular Team has completed more than 100 Hybrid A-fib procedures.

This hybrid ablation therapy that providers at Norton Heart & Vascular Institute have performed for the past four years encompasses two separate minimally invasive procedures. One procedure is performed by a cardiothoracic surgeon on the outside of the heart and the other by an electrophysiologist on the inside of the heart. By treating the inside and outside of the heart, the Hybrid A-fib therapy targets two key trigger areas or sources for A-fib.

“Ablation inside the heart has been performed in the cardiac catheterization lab to treat A-fib for years. This new procedure also treats the outside of the heart, potentially providing a more effective treatment,” Steven Peterson, M.D., cardiothoracic surgeon, Norton Cardiothoracic Surgery. “The hybrid procedure using this inside/outside approach has been shown to be more effective treating patients with more persistent A-fib than a catheter ablation procedure alone. Our goal with this procedure is to help reduce the burden of A-fib and its impact on quality of life.”

For the first part of the hybrid ablation procedure, a cardiothoracic surgeon uses heat generated by radio frequency to create small amounts of scar tissue on the posterior wall outside of the heart a common trigger area of  A-fib.

The second procedure is performed several weeks after the first and is a standard catheter ablation. Heat is applied to the tissue inside the left atrium often including the pulmonary veins, another source of A-fib. By doing both procedures, physicians are able to address these triggers for A-fib from the outside as well as the inside of the heart.

“The American Heart Association estimates there are at least 2.7 million people in the United States with A-fib. Approximately 45% of those patients have long-term, persistent A-fib and have not had many treatment options until the advent of hybrid ablation,” said Kent Morris, M.D., MBA, electrophysiologist and associate director, cardiology, Norton Heart & Vascular Institute. “If not treated, A-fib can lead to an increase in the risk for stroke, heart failure and other symptoms or complications. We’re glad to have this procedure in our arsenal to help treat these patients where previously there were limited options.”