What does this research mean for the field?

The convergent procedure resulted in 43.5% of patients being AF-free off anti-arrhythmic drugs at 12 months and improved safety with complication rates decreasing to 1.2%. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

The research evaluates the safety and efficacy of the hybrid convergent ablation procedure in patients with longstanding persistent atrial fibrillation.

February 8, 2026

The hybrid ablation approach to treating long-standing persistent atrial fibrillation: real-world data from a tertiary institution

Key Result

The hybrid convergent procedure achieved 65.3% AF-free survival on AADs and 43.5% off AADs at 12 months in longstanding persistent AF patients.

Key Points

The research evaluates the safety and efficacy of the hybrid convergent ablation procedure in patients with longstanding persistent atrial fibrillation.
91 patients with longstanding persistent atrial fibrillation were observed.
Patients underwent subxiphoid endoscopic ablation followed by catheter ablation.
Follow-up assessments included Holter monitoring and echocardiograms at 3 and 12 months.
After 12 months, AF-free survival was 65.3% on anti-arrhythmic drugs (AADs) and 43.5% off AADs.
At a median follow-up of 32.3 months, arrhythmia-free survival was 48.4% on AADs and 33.7% off AADs.
Complication rates decreased from 4.3% to 1.2% over the study period with improved techniques.

Structured PICO

Does hybrid convergent ablation improve AF-free survival in patients with longstanding persistent atrial fibrillation?

Population

91 consecutive patients with longstanding persistent atrial fibrillation (PeAF)

Intervention

Hybrid convergent ablation (subxiphoid endoscopic ablation of the posterior left atrium followed by catheter ablation)

Outcome

AF-free survival at 12 months

The hybrid convergent ablation procedure provides reasonable AF-free survival in longstanding persistent AF, with safety improving over time due to refined access techniques and operator experience.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Background Maintenance of sinus rhythm is challenging in patients with longstanding persistent atrial fibrillation (PeAF). Minimally invasive surgical AF ablation may improve outcomes when combined with catheter ablation (the hybrid convergent ablation). This real world data series evaluates the safety and efficacy of the convergent procedure in longstanding PeAF. Methods 91 consecutive patients with longstanding PeAF underwent subxiphoid endoscopic ablation of the posterior left atrium followed by catheter ablation from 2013 to 2022 at a single tertiary within the dedicated hybrid theatre. Median age was 64.4 years with a BMI of 30.3kg/m2. Median duration of AF was 50.4 months with an LA diameter of 45.7mm. The primary outcome was AF-free survival at 12 months; secondary outcomes included change in EHRA class, echocardiographic data, procedural complications, freedom from anti-arrhythmic drugs (AADs), and long term arrhythmia-free survival. All patients underwent 72 Holter monitoring at 3 months and then 12 months post procedure with an echocardiogram at baseline and then at 12 months. Holter monitoring at 6 months was dependant on clinical status. Results After 12 months, the convergent procedure was associated with increased AF-free survival on AADs (65.3%) and off AADs (43.5%). Allowing for multiple procedures, after 32.3 ± 12.7 months' follow-up the convergent procedure was associated with arrhythmia-free survival on AADs (48.4%) and off AADs (33.7%). Complication rates were 4.3% until 2018 over the first 5 year data outcomes, followed by 1.2% with no major complications over the next 5 years following a change from subdiaphragmatic access to subxiphoid access and increased operator experience. Conclusions In longstanding Persistent AF, the convergent procedure is associated with improved arrhythmia-free survival. Complication rates over time have improved due to changes in the access and operator experience.

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