Key result
Hybrid Convergent ablation achieved freedom from atrial arrhythmias in 69% of patients (95% CI 61-78%) at 1 year or later, with a 30-day major adverse event rate of 6%.
Why the study?
To evaluate the safety and effectiveness of contemporary Hybrid Convergent procedures combining epicardial and endocardial ablation for atrial fibrillation.
Does Hybrid Convergent ablation improve freedom from atrial arrhythmias in patients with drug-refractory persistent and longstanding persistent atrial fibrillation?
Meta-Analysis (n=551)
Does Hybrid Convergent ablation improve freedom from atrial arrhythmias in patients with drug-refractory persistent and longstanding persistent atrial fibrillation?
Hybrid Convergent ablation is an effective strategy for persistent and longstanding persistent AF, achieving 69% freedom from atrial arrhythmias at 1 year with a 6% 30-day major adverse event rate.
Supports Hybrid Convergent ablation for refractory persistent AF; extends pooled evidence beyond prior series.
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.
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Shrestha et al. (2022) conducted a meta-analysis in Atrial fibrillation (n=551). Hybrid Convergent ablation was evaluated on Freedom from atrial arrhythmias (95% CI 61-78). Hybrid Convergent ablation achieved freedom from atrial arrhythmias in 69% of patients (95% CI 61-78%) at 1 year or later, with a 30-day major adverse event rate of 6%.
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