The need of a hybrid approach for the treatment of atrial fibrillation

Atrial fibrillation represents nowadays one of the most important burdens in the field of arrhythmia. Albeit often inadequate, medical treatment is still considered the "first-step" approach. Non-pharmacological strategies, either surgical or interventional, recently gained an increasing interest among both cardiac surgeons and electrophysiologists. From the surgical standpoint, the introduction of different energy sources and the development of minimally invasive techniques as an alternative to the original "cut-and-sew" technique allowed a new dawn in the surgical treatment of atrial fibrillation. In the meanwhile, electrophysiologists developed more complex ablation systems that allowed the creation of linear lesions, similar to the surgical ones, while mapping the atria with three-dimensional (3D) navigation systems. Nevertheless, the success rate in terms of sinus rhythm restoration was around 80%-85% in both fields. We foresee that the combination of the two approaches (i.e., surgical and percutaneous approach), in common hybrid approach, will allow a substantial reform for the definitive cure of atrial fibrillation, either paroxysmal or permanent, providing the highest success rates along with the best care for patients' health.