Hybrid ablation

Combination of electrophysiological examination and catheter treatment as well as surgical ablation - the principle of the "best of two worlds". The hybrid procedure is especially suitable for patients with long-standing atrial fibrillation.

Combining expertise: The best of two worlds

The minimally invasive hybrid ablation procedure combines the expertise and technologies of electrophysiology and cardiac surgery. Hybrid ablation is made of two treatment strategies: Electrophysiological examination and treatment with the catheter from the inside, and surgical ablation and left atrial appendage closure from the outside. Recent studies show that the combination of both methods significantly improves outcomes in complex, persistent atrial fibrillation cases. The procedure is offered in a single session in the hybrid operating room or in two sessions with an interval offered by two different specialists.

The minimally invasive hybrid ablation procedure combines the expertise and technologies of electrophysiology and cardiac surgery into one procedure. Hybrid ablation combines two treatment strategies:

1 - The electrophysiological examination and treatment with the catheter from the inside (catheter ablation).

2 - Surgical ablation from the outside. 

The individual situation decides whether surgical or non-surgical intervention is performed first. Often the originally planned second interventions are no longer necessary.

Electrophysiology and heart surgery  

At the Heart & Rhythm center, we do a "teamwork" between the electrophysiologist and the heart surgeon which enables this range of therapies. We recommend the combination of 3D mapping techniques (display of the ECG in three dimensions by measurements in the heart), epicardial ablation (on the heart surface) and left atrial appendage closure as the best therapy for patients with complex atrial fibrillation. Before the intervention, the therapy combination between the electrophysiologist and the cardiac surgeon is discussed in detail and implemented as a HeartTeam decision in accordance with the latest guidelines. This is unique in Switzerland. 

Target population or hybrid approach

The hybrid procedure is particularly indicated in patients with long-standing atrial fibrillation, enlarged left atria, long standing hypertension or in those who the catheter therapy was unsuccessful. Especially complex situations like atypical atrial flutter can be treated with a hybrid procedure. 

Advantages and results of hybrid treatment

Our experience shows, that one year after treatment, most patients remain in normal sinus rhythm even without medications. 

There are several ways to do a hybrid procedure. We make a so-called "staged hybrid". First, surgical ablation is performed, which consists of epicardial ablations. These ablations target the pulmonary veins, the interatrial septum and many other places where extra pulmonary triggers can be identified. But most importantly the left atrial appendage is excluded and electrically isolated. In a second procedure, catheter ablation is performed, if necessary, to close any gaps after surgery. Hybrid ablations in persistent atrial fibrillation provide a success rate of over 80% with a very significant increase in quality of life (QOL). 


There are different ways to perform a hybrid intervention for atrial fibrillation, we advocate the so-called "staged hybrid" concept. This means that electrophysiological and surgical interventions are performed separately in time and only when needed. This leads to an avoidance of unnecessary ablations and thus also increases long-term safety for patients without reducing effectiveness. The focus is on treating the patient as effectively as necessary and as gently as possible.


What is surgical ablation?

Surgical ablation, also called thoracoscopic ablation, is a minimally invasive surgery. It is performed by a cardiac surgeon under general anesthesia. A camera and instruments are inserted through small incisions in the chest wall, and then the ablation is performed on the heart and the left atrial appendage is removed.

What are the advantages of surgical ablation?

Few complications, minimally invasive and therefore no opening of the chest, less medication, very good long-term results. Discontinuation of blood thinners, due to the removal of the left atrial appendage performed in the same procedure.

What is the difference between cryo and radiofrequency ablation?

Both are techniques from electrophysiology and enable the sclerosing of heart tissue by cold (cryo) or heat (radiofrequency). This tissue leads to fibrosis and scarring. The study "Fire and Ice" has shown that there is not much difference between the two techniques. Cryo treatment is usually faster than radiofrequency treatment.
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