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Left to right, electrophysiologists Bharath Reddy, MD, and Brian Wong, MD, and attending cardiothoracic surgeon Iosef Gulkarov, MD, collaborate to perform hybrid ablation procedures.

New York Methodist Hospital cardiac surgeons and cardiologists offer a new hybrid ablation (scar-tissue forming) technique that can help patients with the most persistent atrial fibrillation (" A-fib") to recover a regular rhythm of the heart. Whereas normal heart tissue is able to conduct electrical impulses-even if that tissue is the source of the heart's electrical malfunction-scar tissue cannot. This is why precise ablation of certain epicardial (exterior) and endocardial (interior) heart tissue can create a new, working electrical pathway.

"Depending on the individual, a wide range of effective treatment options are available for A-fib, including medication, electrophysiology and surgery," said Anthony Tortolani, MD, chairman of surgery and cardiothoracic surgery. "However, for those whose A-fib has persisted despite these approaches, hybrid ablation techniques combine the most beneficial aspects of both cardiac surgery and electrophysiology into a single, minimally invasive procedure. The collaboration of the two disciplines allows us to address electrical malfunctions on both the outside and inside of the heart. And the minimally invasive approach allows patients to undergo a complex heart procedure and usually leave the Hospital within 72 hours. Hybrid ablation is a safe way to improve quality of life and reduce the risk for complications of A-fib in these patients."

The hybrid ablation procedure is performed at NYM by cardiothoracic surgeons Iosif Gulkarov, MD, and Berhane Worku, MD, and cardiac electrophysiologists Brian Wong, MD, and Bharath Reddy, MD During the surgical portion of the procedure, Dr. Gulkarov and Dr. Worku use a specialized endoscope to access the heart through a small incision in the patient's abdomen. They then use radiofrequency (focused heat) ablation to produce scar tissue on the heart's surface. Next, Dr. Wong or Dr. Reddy uses live x-ray guidance to thread an ablation catheter (tube) through an artery in the patient's leg up to the inside of the heart. He then evaluates a three-dimensional, computer-generated map of the heart's electrical system to ensure that the abnormal electrical signals have been interrupted, performing any additional ablations necessary on the interior of the heart to fine tune the new electrical pathway.

"This procedure exemplifies the future of treatments for heart conditions, because it relies on the convergence of both technology and technique," said Terrence Sacchi, MD, chief of cardiology. "Cardiothoracic surgeons and cardiologists bring unique and crucial skills to the treatment of heart conditions. A normal heartbeat is an incredibly sophisticated electrical process, which is why A-fib can require an equally sophisticated approach to treatment. We're proud to be able to help so many of our patients get the rhythm back.