Relative Contraindications
There are several groups of patients who may be contraindicated for
hybrid procedures or who may be deemed riskier and potentially have a
longer recovery time. As with other surgical procedures, patients with
gastroesophageal reflux disease, severe renal insufficiency, in ability
to tolerate anesthesia, acute infection such as sepsis/systemic
infection, endocarditis, and localized surgical site infections.
Additionally, there are several factors that disqualify a patient as a
candidate specific to Hybrid Convergent ablation. Patients with a prior
pericardiotomy have scar tissue formed around the heart and between the
heart and surrounding structure, including the lungs. This makes future
heart surgeries and procedures more challenging and thus are not
recommended for hybrid approaches. The presence of a left atrial
thrombus brings an increased risk of stroke and thromboembolism
surrounding catheter ablation procedures. Thus, these patients should be
treated with oral AADs for at least 3 weeks with a repeat
transesophageal echocardiogram or other non-invasive multimodality
imaging before considering a hybrid ablation
procedure.8