Safety and Efficacy of Convergent Hybrid Procedure Using Cryo as Endocardial Energy Source for the Treatment of Atrial Fibrillation

Makati, Kevin J.; Sherman, Andrew J.; Gerogiannis, Iraklis S.; Sood, Nitesh

doi:10.1161/circep.120.008556

Cited by 11 publications

(29 citation statements)

References 3 publications

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“…Further, since there is recovery of electrical conduction following epicardial ablation, it remains important to undertake both components of the hybrid technique to achieve long-lasting, widespread transmurality [ 63 ]. Observational clinical outcomes from contemporary analyses have suggested favourable outcomes with this technique [ 64 , 65 , 66 , 67 , 68 ], which were recently corroborated by the results of the multi-centre, randomised controlled CONVERGE trial [ 69 ]. The trial compared hybrid Convergent ablation with endocardial catheter ablation in PersAF and LSPersAF and met its primary safety and effectiveness endpoints.…”

Section: The Posterior Wall Of the Left Atrium In Non-paroxysmal Atrial Fibrillationmentioning

confidence: 88%

Persistent Atrial Fibrillation: The Role of Left Atrial Posterior Wall Isolation and Ablation Strategies

Kaba

Momin

Camm

2021

JCM

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Atrial fibrillation (AF) is a global disease with rapidly rising incidence and prevalence. It is associated with a higher risk of stroke, dementia, cognitive decline, sudden and cardiovascular death, heart failure and impairment in quality of life. The disease is a major burden on the healthcare system. Paroxysmal AF is typically managed with medications or endocardial catheter ablation to good effect. However, a large proportion of patients with AF have persistent or long-standing persistent AF, which are more complex forms of the condition and thus more difficult to treat. This is in part due to the progressive electro-anatomical changes that occur with AF persistence and the spread of arrhythmogenic triggers and substrates outside of the pulmonary veins. The posterior wall of the left atrium is a common site for these changes and has become a target of ablation strategies to treat these more resistant forms of AF. In this review, we discuss the role of the posterior left atrial wall in persistent and long-standing persistent AF, the limitations of current endocardial-focused treatment strategies, and future perspectives on hybrid epicardial–endocardial approaches to posterior wall isolation or ablation.

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Section: The Posterior Wall Of the Left Atrium In Non-paroxysmal Atrial Fibrillationmentioning

confidence: 88%

Persistent Atrial Fibrillation: The Role of Left Atrial Posterior Wall Isolation and Ablation Strategies

Kaba

Momin

Camm

2021

JCM

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“…Two studies have reported significantly fewer complications in cases in which the subxiphoid approach was used compared with the transdiaphragmatic approach. 64,65 Wats et al published a comprehensive review of clinical outcomes following hybrid convergent ablation that spanned this evolution of the procedure, from its early inception to the lead-up to the CONVERGE clinical trial. 58 The CONVERGE trial randomised patients with symptomatic, drugrefractory, persistent and longstanding persistent AF to hybrid epicardialendocardial convergent ablation (PVI, posterior wall isolation and CTI) or endocardial RF catheter ablation (PVI, roof line, CTI and complex fractionated atrial electrograms at the discretion of the operator).…”

Section: Hybrid Convergent Ablationmentioning

confidence: 99%

“…Several recent observational studies have reported clinical performance and safety results using the same lesion strategy and unipolar device as CONVERGE, including one propensity score-matched study in which the lesion strategy and device were compared with endocardial catheter ablation. 64,65,67,68 A recent review by DeLurgio et al discussed the results of CONVERGE with regard to the published observational studies that compared hybrid convergent ablation with endocardial catheter ablation, the observed reduction in AF burden that has been reported during follow-up after the procedure, and outcomes in the long-standing persistent AF population. 69 As hybrid convergent ablation evolved, physicians performing the procedure gained experience to develop best practices with respect to institutional set up, multidisciplinary heart team collaboration, patient selection, medication strategies, procedural execution and follow-up care.…”

Section: Hybrid Convergent Ablationmentioning

confidence: 99%

“…CONVERGE and other published studies used irrigated RF catheters for endocardial ablation, however, some investigators have incorporated the use of endocardial cryoballoon in hybrid convergent procedures. 65,72 Endocardial cryoballoon was reported to be non-inferior to RF ablation for paroxysmal AF treatment, and the STOP PERSISTENT AF trial demonstrated safety and effectiveness of endocardial cryoballoon for the treatment of early (duration less than 6 months) persistent AF. 73,15 Outcomes of hybrid convergent ablation using endocardial cryoballoon have not been formally compared with endocardial RF ablation and may be relevant for future evaluation.…”

Section: Hybrid Convergent Ablationmentioning

confidence: 99%

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A Chronicle of Hybrid Atrial Fibrillation Ablation Therapy: From Cox Maze to Convergent

Kaba

Ahmed

Behr

et al. 2022

Arrhythm Electrophysiol Rev

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The burden of AF is increasing in prevalence and healthcare resource usage in the UK and worldwide. It can result in impaired quality of life for affected patients, as well as increased risk of stroke, heart failure and mortality. A holistic, integrated approach to AF management is recommended, which may include a focus on reducing risk factors and on medical management with anticoagulation and anti-arrhythmic drugs. There are also various ablation strategies that may be considered when anti-arrhythmic drugs fail to alleviate symptoms and reduce AF burden. These ablation techniques range from standalone percutaneous endocardial catheter ablation to open surgical ablation procedures concomitant with cardiac surgery. More recently, hybrid ablation that combines aspects of both surgical and electrophysiologically targeted ablation has been described. This article reviews the evolution of ablation strategies, beginning with the origin of the Cox maze IV procedure and continuing to the recent hybrid convergent approach, and provides a summary of the associated outcomes.

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“…Cryoballoon for PVI has been adopted and while it was not permitted in CONVERGE, some investigators have reported on its use in the hybrid convergent procedures. 28,35,36 Several questions also remain regarding the relative effectiveness of the hybrid convergent procedure in subpopulations of patients with advanced AF, such as in those patients with prior ablations compared with those undergoing the procedure de novo.…”

Section: Other Ablation Studies In Advanced Afmentioning

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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Safety and Efficacy of Convergent Hybrid Procedure Using Cryo as Endocardial Energy Source for the Treatment of Atrial Fibrillation

Cited by 11 publications

References 3 publications

Persistent Atrial Fibrillation: The Role of Left Atrial Posterior Wall Isolation and Ablation Strategies

Persistent Atrial Fibrillation: The Role of Left Atrial Posterior Wall Isolation and Ablation Strategies

A Chronicle of Hybrid Atrial Fibrillation Ablation Therapy: From Cox Maze to Convergent

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

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