New hope for patients and challenges for the multidisciplinary arrhythmia team: a hybrid convergent approach for atrial fibrillation treatment

Buchta, Piotr; Sierpiński, Radosław; Myrda, Krzysztof; Filipiak‬, Krzysztof J.; Kowalski, Oskar; Bratkowski, Witold; Kalarus, Zbigniew; Gąsior, Mariusz; Zembala, Michał

doi:10.33963/kp.15640

Cited by 4 publications

(5 citation statements)

References 17 publications

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“…It can also be confirmed by the analysis of patients with CHF included in the CABANA trial, in which additional ablation lines, parasympathetic ganglion ablation, or an ablation strategy based on the recording of local atrial potentials were allowed [19]. The high efficacy of hybrid ablation with minimally invasive access in the maintenance of the sinus rhythm could also support this approach [30,31].…”

Section: Discussionmentioning

confidence: 84%

Temporary Trends Concerning the Extent and Efficacy of Atrial Fibrillation Ablation Using Radiofrequency Energy in a Polish Single-Center Experience

et al. 2022

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Background and Objectives: Atrial fibrillation (AF) is the most common supraventricular arrhythmia. Currently, catheter ablation is a preferred treatment strategy. The main objective of our study was a temporary trends analysis of patients’ data undergoing a single AF ablation procedure using radiofrequency energy (RF). The efficacy of the procedure underwent assessment during a 12-month follow-up. Materials and Methods: We analyzed 585 consecutive patients with symptomatic, recurrent, and drug-refractory AF hospitalized in our department between 2013 and 2018 who underwent RF ablation supported by a 3D electroanatomical system. The baseline characteristics, periprocedural parameters, and efficacy of the procedure at 6-, 9- and 12-month follow-ups were analyzed over the years. Results: The number of patients undergoing ablation increased. Patients with paroxysmal AF predominated (71.5%). However, the number of patients with the persistent type of arrhythmia increased over the years. The percentage of patients with chronic heart failure (CHF) increased to 27.5% in 2018, and patients presented with increasingly larger left atria (LA). In all patients, circumferential pulmonary vein isolation was performed. The percentage of patients who underwent arrhythmogenic substrate modification and cavotricuspid isthmus ablation increased. Over the years, the efficacy of a single procedure at the 12-month follow-up remained without significant differences between the years (72.0%, 69.6%, 75.5%, 74.8%, 71.7%, 71.7%). Conclusions: The rate of patients with CHF and advanced LA disease undergoing more extensive ablation increased over the years. The efficacy of a single procedure remained without significant differences between the years.

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Section: Discussionmentioning

confidence: 84%

Temporary Trends Concerning the Extent and Efficacy of Atrial Fibrillation Ablation Using Radiofrequency Energy in a Polish Single-Center Experience

et al. 2022

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“…Among recent single-arm studies, cardioversion for endocardial ablation ranged between 8.3% and 12.9%. [29][30][31] Buchta et al 32 also evaluated long-term cardioversion before and after hybrid ablation in AF and found a significant reduction in cardioversions 12 months after the procedure compared to 12 months before the procedure (p = .003). This was also true when the timeframe was extended to 3 years following the procedure compared to 3 years before the procedure (p = .015).…”

Section: Converge Trial Resultsmentioning

confidence: 99%

“…This was also true when the timeframe was extended to 3 years following the procedure compared to 3 years before the procedure (p = .015). 32 T A B L E 1 Cardioversion rates associated with the hybrid convergent procedure in published literature. The CONVERGE trial reported a 30-day MAE rate of 7.8%, which was below the protocol-specified safety goal.…”

Section: Converge Trial Resultsmentioning

confidence: 99%

The hybrid convergent procedure for persistent and long‐standing persistent atrial fibrillation from an electrophysiologist's perspective

Delurgio

2022

Cardiovasc electrophysiol

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In atrial fibrillation (AF), the pulmonary veins (PVs) are central to arrhythmogenicity and are targeted by PV isolation (PVI). As AF progresses, triggers become more prevalent in non‐PV areas including the left atrial posterior wall (LAPW). Reported benefits of LAPW isolation in Cox‐maze IV led to exploration of ablation strategies using endocardial catheters. However, no single approach to endocardial LAPW isolation exists. Relative success in comparison to PVI alone has been mixed. The hybrid convergent procedure was developed to combine minimally invasive surgical and electrophysiology techniques to accomplish effective PVI and LAPW isolation. Epicardial LAPW isolation is performed by a cardiothoracic surgeon followed by endocardial ablation by an electrophysiologist who ensures PVI completion and targets any remaining gaps. Safety and effectiveness of hybrid convergent were evaluated in the prospective, multicenter, randomized controlled trial, Convergence of Epicardial and Endocardial Ablation for the Treatment of Symptomatic Persistent AF (CONVERGE). CONVERGE compared the effectiveness of the hybrid convergent procedure to endocardial catheter ablation for treatment of drug‐refractory persistent and long‐standing persistent AF and demonstrated primary effectiveness of higher freedom from atrial arrhythmias absent new/increased dose previously failed/intolerant antiarrhythmic drugs through 12 months compared to endocardial catheter ablation. Greater freedom from AF and proportion of patients experiencing ≥90% burden reduction with hybrid convergent ablation were seen through 18 months of follow‐up. Improved electrophysiology lab efficiency was demonstrated by the reduction in endocardial ablation time with addition of epicardial ablation. This multidisciplinary heart team procedure may improve outcomes in difficult‐to‐treat patients with advanced AF.

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“…However, more recent studies have not only shown a much lower risk of major complications (<2%), but also a significantly lower need for repeat procedures (<20%) [25,47,48]. Also, a small subset of patients with persistent and long-standing AF may benefit from a hybrid approach, integrating the strengths of both surgical and catheter ablation [69,70]. There are also limited data regarding AF ablation and left atrial appendage occlusion performed as a single procedure; to integrate the 'cure' for AF and prevent stroke complications, in order to avoid the risk associated with repeated procedures [71][72][73].…”

Section: Expert Opinion On the Future Of Af Managementmentioning

confidence: 99%

Clinical outcomes following rhythm control for atrial fibrillation: is early better?

Kotalczyk

Ding

Gupta

et al. 2021

Expert Review of Cardiovascular Therapy

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Introduction: An integral aspect of atrial fibrillation (AF) management involves better symptom control, incorporating a rate control, rhythm control, or a combination strategy. The 2020 ESC Guidelines suggest that rhythm control strategy should be recommended for symptomatic patients, to mitigate their symptoms and improve the quality of life. However, adequately powered randomized control trials and prospective 'real-world' registries are needed to fully assess the impact of early rhythm control strategies on clinical outcomes in patients with AF. Objective: In this narrative review, we discuss clinical outcomes following rhythm management approach among patients with AF, considering the effectiveness of an early intervention strategy. Expert opinion: Patients involvement and shared decision-making are crucial when deciding the optimal management strategy among patients with AF. For those with newly diagnosed symptomatic AF, an early invasive approach such as catheter ablation may have a role in preventing AF progression and subsequent pathophysiological changes.

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New hope for patients and challenges for the multidisciplinary arrhythmia team: a hybrid convergent approach for atrial fibrillation treatment

Cited by 4 publications

References 17 publications

Temporary Trends Concerning the Extent and Efficacy of Atrial Fibrillation Ablation Using Radiofrequency Energy in a Polish Single-Center Experience

Temporary Trends Concerning the Extent and Efficacy of Atrial Fibrillation Ablation Using Radiofrequency Energy in a Polish Single-Center Experience

The hybrid convergent procedure for persistent and long‐standing persistent atrial fibrillation from an electrophysiologist's perspective

Clinical outcomes following rhythm control for atrial fibrillation: is early better?

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