Hybrid Convergent ablation for atrial fibrillation: A systematic review and meta-analysis

Suvash Shrestha, Kristen M. Plasseraud, Kevin Makati, Nitesh Sood, Ammar M. Killu, Tahmeed Contractor, Syed Ahsan, David B. De Lurgio, Christian C. Shults, Zayd A. Eldadah, Andrea M. Russo, Bradley Knight, Yisachar Jesse Greenberg, Felix Yang*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)396-404
Number of pages9
JournalHeart Rhythm O2
Volume3
Issue number4
DOIs
StatePublished - Aug 2022

Keywords

  • Atrial fibrillation
  • Electrophysiology
  • Hybrid ablation
  • Meta-analysis
  • Surgical ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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