Comparative Effectiveness of Hybrid Ablation Versus Endocardial Catheter Ablation Alone in Patients With Persistent Atrial Fibrillation

Kress, David C.; Erickson, Lynn; Choudhuri, Indrajit; Zilinski, Jodi; Mengesha, Tadele; Krum, David; Sra, Jasbír

doi:10.1016/j.jacep.2016.10.010

Cited by 30 publications

(31 citation statements)

References 26 publications

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“…In a retrospective study of consecutive patients, Kress et al compared convergent ablation with endocardial-only ablation in 133 patients with persistent and long-standing AF. [ 52 ] In this series, cryoballoon was primarily used for endocardial ablation in both procedures. They found the convergent group had fewer recurrences than the endocardial-only group, and 16-month AF-free survival was 72% with convergent ablation compared with 51% for endocardial-only ablation (p=0.01).…”

Section: Evidence For Convergent Ablationmentioning

confidence: 99%

The Convergent Atrial Fibrillation Ablation Procedure: Evolution of a Multidisciplinary Approach to Atrial Fibrillation Management

Wats¹,

Kiser²,

Makati³

et al. 2020

Arrhythmia &Amp; Electrophysiology Review

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The treatment of AF has evolved over the past decade with increasing use of catheter ablation in patients refractory to medical therapy. While pulmonary vein isolation using endocardial catheter ablation has been successful in paroxysmal AF, the results have been more controversial in patients with long-standing persistent AF where extrapulmonary venous foci are increasingly recognised in the initiation and maintenance of AF. Hybrid ablation is the integration of minimally invasive epicardial ablation with endocardial catheter ablation, and has been increasingly used in this population with better results. The aim of this article was to analyse and discuss the evidence for the integration of catheter and minimally invasive surgical approaches to treat AF with specific focus on convergent ablation and exclusion of the left atrial appendage using a surgically applied clip.

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Section: Evidence For Convergent Ablationmentioning

confidence: 99%

The Convergent Atrial Fibrillation Ablation Procedure: Evolution of a Multidisciplinary Approach to Atrial Fibrillation Management

Wats¹,

Kiser²,

Makati³

et al. 2020

Arrhythmia &Amp; Electrophysiology Review

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“…Anesthesia and monitoring were performed as previously described. 20 General anesthesia was induced in all patients in the electrophysiology operating room. Hemodynamic monitoring was performed throughout the procedure, and transesophageal echocardiography was used to exclude thrombus in the LA appendage.…”

Section: Anesthesia and Monitoringmentioning

confidence: 99%

“…Patients underwent epicardial ablation of the posterior LA wall using a transabdominal endoscopic approach followed by endocardial catheter ablation, with the goal of posterior wall isolation. 20 Briefly, a 12-mm port through a 2-cm midline incision and two 5-mm ports were placed for instruments and carbon dioxide insufflation. A 30-or 40-cm cannula (Subtle, AtriCure, Inc.) was placed through a 2-cm opening in the central tendon of the diaphragm and guided into the oblique sinus with a 6.5-mm scope.…”

Section: Hybrid Ablationmentioning

confidence: 99%

“…Immediately following epicardial ablation, endocardial ablation was performed as previously described by Kress et al 20 In brief, after obtaining venous access, a 20-pole diagnostic catheter (St. Jude Medical) was advanced under fluoroscopic guidance into the coronary sinus. Diagnostic quadripolar catheters were positioned at the right atrial appendage and His bundle positions.…”

Section: Hybrid Ablationmentioning

confidence: 99%

“…19 The hybrid approach was shown to be successful in the challenging setting of persistent or long-standing persistent AF, and a study by our center demonstrated that patients receiving the hybrid procedure had fewer repeat ablations and less recurrence at 16 months. 20 It has been shown that atrial flutter (AFL) encompasses approximately half of recurrences when simple endocardial ablation techniques are used; [21][22][23] furthermore, treating recurring AF in this population can be relatively challenging. 24 Thus, our center sought to characterize arrhythmia recurrence after hybrid ablation in the setting of persistent and long-standing persistent AF.…”

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Characterizing Recurrence Following Hybrid Ablation in Patients With Persistent Atrial Fibrillation

Kress

Erickson

Mengesha

et al. 2020

Journal of Patient-Centered Research and Reviews

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Journal of Patient-Centered Research and Reviews (JPCRR) is an open access, peer-reviewed medical journal focused on disseminating scholarly works devoted to improving patient-centered care practices, health outcomes, and the patient experience. Purpose It is widely accepted that atrial fibrillation (AF) accounts for half of arrhythmia recurrences following endocardial catheter ablation of AF. An epicardial-endocardial approach (hybrid) has emerged as an alternative to endocardial ablation alone for the treatment of AF, yet recurrence after a hybrid procedure has not been well characterized. This retrospective study is aimed at characterizing recurrence following hybrid ablation for patients with persistent AF. Methods Patients with persistent AF (N=108) received both endocardial and epicardial ablation of the posterior left atrial wall using catheter ablation and a small midline surgical approach (hybrid). Presence of atrial flutter or AF was determined with ambulatory monitoring (n=22) or electrocardiogram analysis (n=86) at each follow-up visit. Recurrence mode was confirmed by electrophysiology study for those patients undergoing subsequent catheter ablation after hybrid ablation. Results Patients were followed for a mean ± standard deviation of 25 ± 14 months. Of patients who had a recurrence, 53% (n=33) were in atrial flutter and 47% (n=29) were in AF. Of those who had a recurrence with atrial flutter, 14 received repeat ablation for either left (n=11) or left/right (n=3) atrial flutter and 3 received AF ablation. Half of ablations for atrial flutter recurrence following the hybrid procedure involved the mitral isthmus. Conclusions Atrial flutter accounts for about half of arrhythmia recurrences post-hybrid ablation. If catheter ablation of the mitral isthmus is considered during the hybrid procedure to prevent subsequent occurrence of perimitral flutter, bidirectional block must be performed to ensure a complete line of block.

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Hybrid convergent ablation versus endocardial catheter ablation for atrial fibrillation: A systematic review and meta‐analysis

Mhanna

Beran

Al‐Abdouh

et al. 2021

Journal of Arrhythmia

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Introduction Endocardial catheter ablation (ECA) for atrial fibrillation (AF) has limited efficacy. Hybrid convergent procedure (HCP) with both epicardial and endocardial ablation is a novel strategy for AF treatment. In this meta‐analysis, we aimed to evaluate the efficacy and safety of HCP in AF ablation. Method We performed a comprehensive literature search for studies that evaluated the efficacy and safety of HCP compared with ECA for AF. The primary outcome was freedom of atrial arrhythmia (AA). The secondary outcome was the periprocedural complication rate. Pooled relative risk (RR) and corresponding 95% confidence intervals (CIs) were calculated using the random effects model. Results A total of eight studies, including 797 AF patients (mean age: 60.7 ± 9.8 years, 366 patients with HCP vs. 431 patients with ECA alone), were included. HCP showed a higher rate of freedom of AA compared with ECA (RR: 1.48, 95% CI: 1.13–1.94, p = .004). However, HCP was associated with higher rates of periprocedural complications (RR: 3.64, 95% CI: 2.06–6.43; p = .00001). Moreover, the HCP had a longer procedure time and postprocedural hospital stay. Conclusions Although hybrid ablation was associated with a higher success rate, this should be judged for increased periprocedural adverse events and extended hospital stay. Prospective large‐scale randomized trials are needed to validate these results.

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Comparative Effectiveness of Hybrid Ablation Versus Endocardial Catheter Ablation Alone in Patients With Persistent Atrial Fibrillation

Abstract: Among patients with persistent AF, hybrid ablation is associated with less AF recurrence and fewer re-do ablations. Prospective large-scale randomized trials are needed to validate these results.

Cited by 30 publications

References 26 publications

The Convergent Atrial Fibrillation Ablation Procedure: Evolution of a Multidisciplinary Approach to Atrial Fibrillation Management

The Convergent Atrial Fibrillation Ablation Procedure: Evolution of a Multidisciplinary Approach to Atrial Fibrillation Management

Characterizing Recurrence Following Hybrid Ablation in Patients With Persistent Atrial Fibrillation

Hybrid convergent ablation versus endocardial catheter ablation for atrial fibrillation: A systematic review and meta‐analysis

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