Exploring the essential aspects of the hybrid approach for atrial fibrillation

In this thesis, several aspects concerning the hybrid approach for the treatment of complex atrial fibrillation were investigated. The first investigation of all articles that are bundled into this thesis concerns the underlying mechanism of atrial fibrillation and describes the association between a certain type of fat surrounding the atria and the occurrence of atrial fibrillation after cardiac surgery. The subsequent articles focused on different outcome measures after a hybrid ablation procedure for complex atrial fibrillation. For example, a systematic review and meta-analysis showed, and this was subsequently confirmed in a randomized study, that the hybrid procedure is more effective in restoring the normal heart rhythm than standard-of-care catheter ablation. The hybrid ablation can also be safely performed from only one side of the chest, and can at the same time be combined with a second minimally invasive cardiac procedure and the ablation also improves the atrial function. Finally, this thesis showed that quality of life improves after surgical ablation, either stand-alone or concurrent with another cardiac surgical procedure.