TY - JOUR
T1 - Hybrid Convergent ablation for atrial fibrillation
T2 - A systematic review and meta-analysis
AU - Shrestha, Suvash
AU - Plasseraud, Kristen M.
AU - Makati, Kevin
AU - Sood, Nitesh
AU - Killu, Ammar M.
AU - Contractor, Tahmeed
AU - Ahsan, Syed
AU - De Lurgio, David B.
AU - Shults, Christian C.
AU - Eldadah, Zayd A.
AU - Russo, Andrea M.
AU - Knight, Bradley
AU - Greenberg, Yisachar Jesse
AU - Yang, Felix
N1 - Funding Information:
Statistical analysis was performed by NAMSA and funded by AtriCure , Inc.
Funding Information:
Statistical analysis was performed by NAMSA and funded by AtriCure, Inc. FY: consultant for AtriCure, Inc. KP: employee, stock ownership at AtriCure, Inc. KM: consultant, advisor, proctor for and has received research grants from AtriCure, Boston Scientific, and Medtronic; speaker bureau for Abbott. NS: consultant for AtriCure, Inc. DD: consultant, speaker bureau for AtriCure, Inc. SA: speaker bureau for AtriCure, Inc, Biosense Webster, and Boston Scientific. CS: consulting fees and honoraria from Medtronic, AtriCure, and Abbott Laboratories. ZE: consultant for AtriCure, Inc. BK: consultant for AtriCure, Inc. AK, TC, YJG: none. All authors attest they meet the current ICMJE criteria for authorship. The authors followed the PRISMA statement for reporting systematic review and meta-analysis in this study.
Publisher Copyright:
© 2022 Heart Rhythm Society
PY - 2022/8
Y1 - 2022/8
N2 - Background: Hybrid Convergent ablation for atrial fibrillation (AF) combines minimally invasive surgical (epicardial) and catheter (endocardial) ablation. The procedural goal is to achieve more extensive, enduring ablation of AF substrate around the pulmonary veins, posterior wall, and vestibule of the posterior wall left atrium. Objective: To perform a systematic review and meta-analysis on safety and effectiveness of contemporary Hybrid Convergent procedures. Methods: PubMed, Embase, and manual searches identified primary research articles on Hybrid Convergent. Inclusion criteria focused on contemporary practices (epicardial ablation device and lesions). Clinical outcomes at 1 year or later follow-up, patient population, procedural details, and major adverse events (MAE) were recorded. Results: Of 249 records, 6 studies (5 observational, 1 randomized controlled trial) including 551 patients were included. Endocardial energy sources included radiofrequency and cryoballoon. Hybrid Convergent ablation was mostly performed in patients with drug-refractory persistent and longstanding persistent AF. Mean preprocedural AF duration ranged between 2 and 5.1 years. Most patients (∼92%) underwent Hybrid Convergent in a single hospitalization. At 1 year follow-up or later, 69% (95% confidence interval [CI]: 61%–78%, n = 523) were free from atrial arrhythmias and 50% (95% CI: 42%–58%, n = 343) were free from atrial arrhythmias off antiarrhythmic drugs. Thirty-day MAE rate was 6% (95% CI: 3%–8%, n = 551). Conclusion: Hybrid Convergent ablation is an effective ablation strategy for persistent and longstanding persistent AF. Contemporary procedural approaches and published strategies aim to mitigate complications reported in early experience and address delayed inflammatory effusions.
AB - Background: Hybrid Convergent ablation for atrial fibrillation (AF) combines minimally invasive surgical (epicardial) and catheter (endocardial) ablation. The procedural goal is to achieve more extensive, enduring ablation of AF substrate around the pulmonary veins, posterior wall, and vestibule of the posterior wall left atrium. Objective: To perform a systematic review and meta-analysis on safety and effectiveness of contemporary Hybrid Convergent procedures. Methods: PubMed, Embase, and manual searches identified primary research articles on Hybrid Convergent. Inclusion criteria focused on contemporary practices (epicardial ablation device and lesions). Clinical outcomes at 1 year or later follow-up, patient population, procedural details, and major adverse events (MAE) were recorded. Results: Of 249 records, 6 studies (5 observational, 1 randomized controlled trial) including 551 patients were included. Endocardial energy sources included radiofrequency and cryoballoon. Hybrid Convergent ablation was mostly performed in patients with drug-refractory persistent and longstanding persistent AF. Mean preprocedural AF duration ranged between 2 and 5.1 years. Most patients (∼92%) underwent Hybrid Convergent in a single hospitalization. At 1 year follow-up or later, 69% (95% confidence interval [CI]: 61%–78%, n = 523) were free from atrial arrhythmias and 50% (95% CI: 42%–58%, n = 343) were free from atrial arrhythmias off antiarrhythmic drugs. Thirty-day MAE rate was 6% (95% CI: 3%–8%, n = 551). Conclusion: Hybrid Convergent ablation is an effective ablation strategy for persistent and longstanding persistent AF. Contemporary procedural approaches and published strategies aim to mitigate complications reported in early experience and address delayed inflammatory effusions.
KW - Atrial fibrillation
KW - Electrophysiology
KW - Hybrid ablation
KW - Meta-analysis
KW - Surgical ablation
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U2 - 10.1016/j.hroo.2022.05.006
DO - 10.1016/j.hroo.2022.05.006
M3 - Article
C2 - 36097459
AN - SCOPUS:85133826137
SN - 2666-5018
VL - 3
SP - 396
EP - 404
JO - Heart Rhythm O2
JF - Heart Rhythm O2
IS - 4
ER -