Low Rate of Atrial Fibrillation Recurrence Verified by Implantable Loop Recorder Monitoring Following a Convergent Epicardial and Endocardial Ablation of Atrial Fibrillation

Abstract

Implantable Loop Recorder Monitoring Outcomes for the Convergent AF Procedure. Objective: Evaluate long‐term outcomes in patients undergoing the Convergent procedure (CP) for the treatment of atrial fibrillation (AF). Background: The CP provides a multidisciplinary approach, combining endoscopic creation of epicardial linear lesions followed by endocardial mapping and ablation and targets persistent and longstanding persistent AF patients who are at increased risk of heart failure, stroke, and mortality. Methods: Outcomes from a prospective nonrandomized study were recorded for consecutive patients by interrogation of implanted Reveal® monitors. Rhythm status and AF burden were quantified 6–24 months postprocedure, and compared relative to AF type, gender, age, body mass index, left atrial size, left ventricular ejection fraction, and congestive heart failure, hypertension, age >75 years, age between 65 and 74 years, stroke/TIA/TE, vascular disease (previous MI, peripheral arterial disease or aortic plaque), diabetes mellitus, female (CHA2DS2VASc). Results: A total of 50 patients were enrolled with 94% having persistent or longstanding persistent AF. There were 2 atrioesophageal fistulas reported. In one patient, the fistula resulted in death at 33 days postprocedure; in the second, the fistula was surgically repaired but patient died 8 months postprocedure from a CVI. After CP, 95% of patients were in sinus rhythm at 6‐month follow‐up; 88% at 12 months; and 87% at 24 months. The median AF burden recorded with Reveal XT monitors was 0.0%, 0.1%, and 0.1% at 6, 12, and 24 months with 81%, 81%, and 87% of patients reporting a burden less than 3%, respectively. Conclusion: Using 24 × 7 continuous loop recording, the CP demonstrated success in treating persistent and longstanding persistent AF patients. Endocardial mapping and catheter ablation with diagnostic confirmation of procedural success complemented the endoscopic creation of epicardial linear lesions in restoring sinus rhythm. (J Cardiovasc Electrophysiol, Vol. 23 pp. 1059‐1066, October 2012)

Hybrid ablation for atrial fibrillation: a systematic review

“…Bipolar RF was used epicardially in six series [15, 27, 38, 40, 41, 46], which equals the reported use of unipolar RF [34–37, 39, 42]. Gaita et al [43] used cryoenergy in their open hybrid procedure, but Kumar et al [44] also used cryoenergy in rare cases thoracoscopically.…”

“…Zembala et al [42] first performed one-stage procedures but changed (due to reimbursement issues) to a two-stage approach with a second admission 15–20 days after the surgical ablation. Richardson et al [41] and Gersak et al [37] performed both, in which the approach depended on operator preferences in the first study. The staged approach was used in 41 % of the patients ( n  = 232).…”

“…Five groups used a bilateral thoracic approach [27, 38, 40, 41, 46], three groups used a right thoracic monolateral approach [34, 35, 39], one used a subxiphoideal approach [42], and two others used a transabdominal transdiaphragmatic approach [36, 37]. The group of Pison et al [15, 23, 32] used bilateral, left and right monolateral thoracoscopic approaches.…”

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…606,607,608,609,610,611,612,613,614,615,616 Before these approaches are applied more widely, a streamlining of the workflow of the dual procedure approach will be required.…”

“…607,609,613, 1368,1377,1378,1379,1380,1381,1382,1383 This procedure has been largely redesigned to prevent these adverse results, and two papers have reported no mortality and no AEF. 613,1381 …”