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

Abstract

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.

Hybrid ablation procedure for the treatment of nonparoxysmal atrial fibrillation: A systematic review and meta‐analysis

“…found no difference between the hybrid procedure and epicardial ablation in the prevention of arrhythmia recurrence, while the hybrid procedure was associated with higher complication rates. Mhanna et al 28 . found significantly higher rates of complications in their meta‐analysis of eight studies (797 AF patients).…”

“…Five meta-analysis articles explored the effectiveness and safety of hybrid ablation for AF. [26][27][28][29][30] The number of prospective controlled studies on nonparoxysmal AF was too small, and these five metaanalysis studies included more single-arm studies or retrospective analysis studies for analysis, and their conclusions were also different.…”

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

“…As a result, the effectiveness of HCA may be underestimated in these studies. Lastly, previous meta-analyses included studies with a variety of surgical techniques (subxiphoid/ unilateral or bilateral thoracoscopic/mini-thoracotomy/sternotomy), which vary in terms of their efficacy and risk profile [ 9 , 18 , 20 , 22 ]. The resultant heterogeneity in these meta-analyses was significant [ 8 , 22 ].…”

“…The resultant heterogeneity in these meta-analyses was significant [ 8 , 22 ]. Mhanna et al reported a heterogeneity of 77% in their primary outcome (freedom from AF at last follow-up), and Zhang et al reported a heterogeneity of 86% in the same outcome [ 9 , 18 ]. A strength of the present study was the inclusion of RCT’s and PSM studies only.…”

“…The ability to ablate the posterior wall, validate these lesions, identify further lesions and ablate further arrhythmogenic substrates makes this approach effective for rhythm maintanence [ 5 ]. Unfortunately, much of the convergent experience comes from single-centre retrospective studies which are prone to bias [ 5 , 9 ].…”