Chair Richard Schilling (London, UK) led a discussion on hybrid convergent therapy for long-standing persistent atrial fibrillation (AF). Case operators Wilber Su and Ken Fang (The University of Arizona College of Medicine, Phoenix, US) performed a staged hybrid procedure, with Dr Fang conducting the surgical portion and Dr Su completing the catheter-based ablation. Panelists Syed Ahsan (London, UK), Mark La Meir (Brussels, BE), and Roderick Tung (Phoenix, US) provided insights into lesion durability, mapping techniques, and the role of epicardial and endocardial ablation strategies.

The case featured a 50-year-old patient with AF for over a decade, undergoing a combined approach using the Episense system for posterior wall ablation and an AtriClip for left atrial appendage exclusion. The discussion explored the benefits of a structured lesion set, the importance of achieving mitral isthmus block, and strategies for ensuring complete posterior wall isolation. The faculty debated optimal mapping thresholds, voltage-guided ablation, and the evolving role of pulsed field ablation in hybrid AF treatment.