Key result
Hybrid convergent ablation significantly increased freedom from atrial fibrillation compared to endocardial catheter ablation (73% vs 49%, OR 2.78), but was associated with higher post-procedural complications.
Why the study?
Hybrid convergent ablation is an emerging procedure with promising results, but its efficacy and safety compared to endocardial catheter ablation alone needed evaluation.
Does hybrid convergent ablation improve freedom from atrial fibrillation compared to endocardial catheter ablation alone in patients with atrial fibrillation?
Meta-Analysis (n=422)
Does hybrid convergent ablation improve freedom from atrial fibrillation compared to endocardial catheter ablation alone in patients with atrial fibrillation?
Odds Ratio: 2.78 (95% CI 1.82–4.24)
Absolute Event Rate: 73% vs 49%
p-value: p=<0.01
Hybrid convergent ablation is associated with higher freedom from atrial fibrillation than endocardial catheter ablation alone, but at the cost of significantly increased post-procedural complications.
HCA may improve long-term AF freedom versus ECA alone despite higher complications; extends RCT and PSM evidence for hybrid strategies.
INTRODUCTION: Atrial fibrillation (AF) is the most common arrhythmia. Hybrid convergent ablation (HCA) is an emerging procedure for treating longstanding AF with promising results. HCA consists of a subxiphoid, surgical ablation followed by completion endocardial ablation. This meta-analysis of randomized control trials (RCT's) and propensity score-matched studies aims to examine the efficacy and safety of HCA compared to endocardial catheter ablation (ECA) alone on patients with AF. METHODS: This review was written in accordance with preferred reporting items for systematic reviews and meta-analyses recommendations and guidance. The primary outcome for the analysis was freedom from AF (FFAF) at final follow up. Secondary outcomes were mortality and significant complications such as tamponade, sternotomy, esophageal injury, atrio-esophageal fistulae post procedurally. RESULTS: = 0). Major post-operative complications were observed in significantly more patients in the HCA group, with an OR of 5.14 (95% CI 1.70-15.54, P < 0.01). There was only one death reported in the HCA cohorts, with no deaths in the ECA cohort. CONCLUSION: HCA is associated with a significantly higher FFAF than ECA, however, it is associated with increased post-procedural complications. There was only one death in the HCA cohort. Large RCT's comparing the HCA and ECA techniques may further validate these results.
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Eranki et al. (2022) conducted a meta-analysis in Atrial fibrillation (n=422). Hybrid convergent ablation vs. Endocardial catheter ablation was evaluated on Freedom from atrial fibrillation at final follow-up (OR 2.78, 95% CI 1.82-4.24, p=<0.01). Hybrid convergent ablation significantly increased freedom from atrial fibrillation compared to endocardial catheter ablation (73% vs 49%, OR 2.78), but was associated with higher post-procedural complications.
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