Hybrid convergent ablation versus endocardial catheter ablation for atrial fibrillation: a systematic review and meta-analysis of randomised control trials and propensity matched studies

Abstract

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 Four studies where included, with a total of 233 patients undergoing HCA and 189 patients undergoing ECA only. Pooled analysis demonstrated that HCA cohorts had significantly higher rates of FFAF than ECA cohorts, with an OR of 2.78 (95% CI 1.82–4.24, P < 0.01, I2 = 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.

Hybrid strategies for stand-alone surgical ablation of atrial fibrillation

“…It is well-known that the inclusion of unmatched retrospective data into meta-analyses may jeopardize the results. Therefore, a recent meta-analysis analyzed the rhythm outcomes of hybrid ablation vs. CA in only randomized-controlled and propensity-matched studies ( 49 ). Authors confirmed how the hybrid group had significantly higher rates of freedom from AF with [odds ratio (OR) =2.78; 95% confidence interval (CI): 1.82–4.24; P<0.001] or without AAD (OR =2.75; 95% CI: 1.63–4.65; P<0.001) than the CA group.…”

Noteworthy in Cardiothoracic Surgery 2023

“…29 The benefit of hybrid ablation over catheter ablation alone is further documented by several meta-analyses. [30][31][32] Given these data, we should anticipate increased uptake among surgeons in the coming years.…”

A Year of Changes: The End of the Pandemic Marks the Beginning of New Priorities

“…62 A meta-analysis showed that hybrid ablation with surgical epicardial ablation along with LAAO followed by endocardial catheter ablation achieved more days free from atrial tachyarrhythmias at final follow-up than endocardial catheter ablation alone. 63 Since DCD was one of the dominating topics of 2023, the authors also recap the American Society of Transplant Surgeons Recommendations on Best Practices in Donation after Circulatory Death Organ Procurement. 64 Last, as morbidity and survival after cardiac surgery continue to improve, the review emphasized the importance of cognitive changes after surgery.…”

“…62 A meta-analysis showed that hybrid ablation with surgical epicardial ablation along with LAAO followed by endocardial catheter ablation achieved more days free from atrial tachyarrhythmias at final follow-up than endocardial catheter ablation alone. 63…”