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