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

• Type of Material: Article
• Authors: Suvash Shrestha, Maimonides Medical Center; Kristen M. Plasseraud, AtriCure, Inc.; Kevin Makati, Tampa Cardiac Specialists; Nitesh Sood, Southcoast Health System; Ammar M. Killu, Mayo Clinic; Tahmeed Contractor, Loma Linda University Medical Center; Syed Ahsan, St Bartholomew's Hospital; David De Lurgio, Emory University; Christian C. Shults, Washington Hospital Center; Zayd A. Eldadah, Washington Hospital Center; Andrea Russo, Cooper Medical School of Rowan University; Bradley Knight, Northwestern University; Yisachar Jesse Greenberg, Maimonides Medical Center; Felix Yang, Maimonides Medical Center
• Language: English
• Date: 2022-08-01
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2022 Heart Rhythm Society. Published by Elsevier Inc.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.hroo.2022.05.006
• Title of Journal or Parent Work: Heart Rhythm O2
• Volume: 3
• Issue: 4
• Start Page: 396
• End Page: 404
• Grant/Funding Information: Statistical analysis was performed by NAMSA and funded by AtriCure, Inc.
• Keywords: Surgical ablation; Meta-analysis; Hybrid ablation; Electrophysiology; Atrial fibrillation
• Research Categories: Health Sciences, Medicine and Surgery

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.