Robotic Hybrid Ablation for Persistent Atrial Fibrillation With Diffuse Pericardial Adhesions.

BACKGROUND: Atrial fibrillation (AF), the most prevalent arrhythmia, poses significant health risks globally, particularly in aging populations. For symptomatic persistent AF resistant to standard treatments, the guidelines recommend hybrid approaches. Convergent hybrid ablation with robotic epicardial surgery enhances access in cases with challenging pericardial adhesions. CASE SUMMARY: We present a case of persistent AF with past catheter ablation complicated by pericardial effusion now presenting with worsening symptoms. Given anticipated pericardial adhesions, convergent hybrid ablation with a robotic-assisted epicardial component was performed, followed by a successful second-stage endocardial ablation. The patient had an uneventful recovery and remains in sinus rhythm. DISCUSSION: This report demonstrates the successful application of a robotic platform to the epicardial component of a Convergent hybrid ablation procedure, in which diffuse adhesions precluded the standard approach. TAKE-HOME MESSAGE: Robotic-assisted hybrid ablation is a novel approach for hybrid ablation for long-standing persistent AF, especially in patients with pericardial adhesions.