Hybrid epicardial-endocardial ablation for long-standing persistent atrial fibrillation: A subanalysis of the CONVERGE Trial

Delurgio, David B.; Blauth, Christopher; Halkos, Michael E.; Crossen, Karl J.; Talton, David; Oza, Saumil R.; Magnano, Anthony R.; Mostovych, Mark A.; Billakanty, Sreedhar R.; Duff, Steven B.; Stees, Christopher; Sperling, Jason S.; Ahsan, Syed; Yap, John; Shults, Christian; Pederson, David R.; Garrison, James L.; Tabereaux, Paul B.; Gilligan, David; Bundy, Graham M.; Costantini, Otto; Espinal, Eric; Pietra, Angelo La; Yang, Felix; Greenberg, Yisachar; Jacobowitz, Israel J.; Gill, Jaswinder

doi:10.1016/j.hroo.2022.11.007

Cited by 11 publications

(9 citation statements)

References 26 publications

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“…A subgroup analysis examining the effectiveness of the Hybrid Convergent procedure for long-standing persistent AF demonstrated an absolute difference of 28.8% (78% improvement; p = .022) in 12-month freedom from AF in the Hybrid group over the endocardial-only group and was sustained through 18 months. 31 The benefit of Hybrid Convergent held when compared with the Catheter Ablation arm and their respective impacts on AF burden reduction as well as freedom from cardioversion and AF symptoms, through 18 months. Along with an acceptable safety profile, these significantly improved outcomes provided the collaborative heart team a new, effective approach for the difficult-to-treat population of patients suffering from advanced AF.…”

Section: Long-standing Persistent Afmentioning

confidence: 99%

“…This is attributed to the lack of a standardized lesion set, limited ability to produce transmural lesions, and dissociation of electrical activity between the endocardium and epicardium. A subgroup analysis examining the effectiveness of the Hybrid Convergent procedure for long‐standing persistent AF demonstrated an absolute difference of 28.8% (78% improvement; p = .022) in 12‐month freedom from AF in the Hybrid group over the endocardial‐only group and was sustained through 18 months 31 . The benefit of Hybrid Convergent held when compared with the Catheter Ablation arm and their respective impacts on AF burden reduction as well as freedom from cardioversion and AF symptoms, through 18 months.…”

Section: Introductionmentioning

confidence: 99%

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Selection of patients for hybrid ablation procedure

Lurgio

2023

Cardiovasc electrophysiol

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Catheter ablation for treatment of symptomatic non‐paroxysmal atrial fibrillation remains challenging. Clinical failure and need for continued medical therapy or repeat ablation is common, especially in more advanced forms of atrial fibrillation. Hybrid ablation has emerged as a more effective and safe therapy than endocardial‐only ablation particularly for longstanding persistent atrial fibrillation as demonstrated by the randomized controlled CONVERGE trial. Hybrid ablation requires collaboration of electrophysiologists and cardiac surgeons to develop specific workflows. This review describes the Hybrid Convergent approach in the context of available ablation options and offers guidance for workflow development and patient selection.

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Section: Long-standing Persistent Afmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Selection of patients for hybrid ablation procedure

Lurgio

2023

Cardiovasc electrophysiol

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“…A subgroup analysis examining the effectiveness of the Hybrid Convergent procedure for long-standing persistent AF demonstrated an absolute difference of 28.8% (78% improvement; p=0.022) in 12-month freedom from AF in the Hybrid group over the endocardial only group and was sustained through 18-months. 28 The benefit of Hybrid Convergent held when compared to the Catheter Ablation arm and their respective impacts on AF burden reduction as well as freedom from cardioversion and AF symptoms, through 18-months. Along with an acceptable safety profile, these significantly improved outcomes provided the collaborative heart team a new, effective approach for the difficult to treat population of patients suffering from advanced AF.…”

Section: Long-standing Persistent Afmentioning

confidence: 99%

Selection of Patients for Hybrid Ablation Procedure

Lurgio

2022

Preprint

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Catheter ablation for treatment of symptomatic non-paroxysmal atrial fibrillation remains challenging. Clinical failure and need for continued medical therapy or repeat ablation is common, especially in more advanced forms of atrial fibrillation. Hybrid ablation has emerged as a more effective and safe therapy than endocardial-only ablation particularly for longstanding persistent atrial fibrillation as demonstrated by the randomized controlled CONVERGE trial. Hybrid ablation requires collaboration of electrophysiologists and cardiac surgeons to develop specific workflows. This review describes the Hybrid Convergent approach in the context of available ablation options and offers guidance for workflow development and patient selection.

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“…In a subanalysis of 65 LSPAF patients (42.5% of the initial 153 patients), freedom from AF/AFL/AT off new or increased dose of previously failed/intolerant AADs through 12 months was 65.8% (25/38) in the Hybrid Convergent arm and 37.0% (10/27) in the CA arm (P=0.022). For the LSPAF subgroup, the rates off AADs were 52.6% (20/38) in the Hybrid Convergent group and 25.9% (7/27) in the CA group (P=0.031) ( 14 ). In the overall PersAF and LSPAF cohort, the 18-month effectiveness outcome of ≥90% AF burden reduction was met in 74% (53/72) of the HC group and 55% (23/42) in the CA group, using 7-day Holter monitoring ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

“…In the overall PersAF and LSPAF cohort, the 18-month effectiveness outcome of ≥90% AF burden reduction was met in 74% (53/72) of the HC group and 55% (23/42) in the CA group, using 7-day Holter monitoring ( 13 ). In the LSPAF subgroup, 73% (27/37) in the Hybrid Convergent group and 36% (9/25) in the CA group had ≥90% AF burden reduction (P=0.004) at 18 months ( 14 ). With the knowledge of the safety and effectiveness of the HC procedure, the objective of the present analysis is to report on the impact of HC ablation on AF symptoms and QOL of patients in the CONVERGE clinical trial.…”

Section: Introductionmentioning

confidence: 99%

Atrial fibrillation symptom reduction and improved quality of life following the hybrid convergent procedure: a CONVERGE trial subanalysis

Gill,

Crossen,

Blauth

et al. 2024

Ann Cardiothorac Surg

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Background CONVERGE was a prospective, multicenter, randomized controlled trial that evaluated the safety of Hybrid Atrial Fibrillation Convergent (HC) and compared its effectiveness to endocardial catheter ablation (CA) for the treatment of persistent atrial fibrillation (PersAF) and longstanding PersAF (LSPAF). In 2020, we reported that CONVERGE met its primary safety and effectiveness endpoints. The primary objective of the present study is to report CONVERGE trial results for quality of life (QOL) and Class I/III anti-arrhythmic drug (AAD) utilization following HC. Methods Eligible patients had drug-refractory symptomatic PersAF or LSPAF and a left atrium diameter ≤6.0 cm. Enrolled patients were randomized 2:1 to receive HC or CA. Atrial Fibrillation Severity Scale (AFSS) and the 36-Item Short Form Health Survey (SF-36) were assessed at baseline and 12 months; statistical comparison was performed using paired t -tests. AAD utilization at baseline through 12 and 18 months post-procedure was evaluated; statistical comparison was performed using McNemar’s tests. Results A total of 153 patients were treated with either HC (n=102) or CA (n=51). Of the 102 HC patients, 38 had LSPAF. AFSS and SF-36 Mental and Physical Component scores were significantly improved at 12 months versus baseline with HC overall and for the subset of LSPAF patients treated with either HC or CA. The proportion of HC patients (n=102) who used Class I /III AADs at 12 and 18 months was significantly less (33.3% and 36.3%, respectively) than baseline (84.3%; P<0.001). In LSPAF patients who underwent HC (n=38), AADs use was 29.0% through 18 months follow-up versus 71.1% at baseline (P<0.001). Conclusions HC reduced AF symptoms, significantly improved QOL, and reduced AAD use in patients with PersAF and LSPAF. ClinicalTrials.gov Identifier NCT01984346.

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Hybrid epicardial-endocardial ablation for long-standing persistent atrial fibrillation: A subanalysis of the CONVERGE Trial

Cited by 11 publications

References 26 publications

Selection of patients for hybrid ablation procedure

Selection of patients for hybrid ablation procedure

Selection of Patients for Hybrid Ablation Procedure

Atrial fibrillation symptom reduction and improved quality of life following the hybrid convergent procedure: a CONVERGE trial subanalysis

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