Efficacy and safety of the convergent atrial fibrillation procedure: a meta-analysis of observational studies

OBJECTIVES: The hybrid ablation via transdiaphragmatic approach (convergent procedure) is a newly emerging treatment for atrial fibrillation. However, the results reported by different centres are controversial. The purpose of this study is to investigate the efficacy and safety of the convergent procedure by performing a meta-analysis. METHODS: We searched the PubMed, EMBASE and Cochrane Library databases and calculated the pooled estimates. The I2 test, χ2 test and meta-regression analysis were performed to evaluate the heterogeneity. Funnel plots were used to detect publication bias. Trim-and-fill method was performed to identify possible asymmetry. RESULTS: In total, 6 observational studies involving 478 patients were identified for the final analysis. The pooled estimated rate of sinus rhythm maintenance within 12 months was 84.3% (χ2 = 14.69, P = 0.012). The meta-regression analysis showed that the mean duration of atrial fibrillation affected the heterogeneity. Two additional studies need to be trimmed according to the trim-and-fill method. The pooled estimate was 60.2% after filling. The overall complication rate was 9.0%, and the mortality rate was 1.7%. CONCLUSIONS: The efficacy of the convergent atrial fibrillation procedure is relatively satisfactory. However, the overall complication incidence is relatively high, and the procedural mortality rate is unacceptable.