Four Year Follow-up of Outcomes of the Hybrid Epicardial-Endocardial Ablation: A Single Center Experience.

BACKGROUND: The CONVERGE trial demonstrated that hybrid epicardial and endocardial ablation was more effective than catheter ablation for treatment of persistent atrial fibrillation at 1 year. Long term real-world outcomes data are scarce.

OBJECTIVE: We describe a single center experience by evaluating the long-term effectiveness and safety of hybrid epicardial-endocardial ablation.

METHODS: This is a retrospective single center study. Patients were followed up to 4 years. The primary endpoint was the rate of AF recurrence up to four years post ablation. Secondary endpoints included the reduction in antiarrhythmic therapy use, the effect of Ligament of Marshall removal, epicardial posterior wall, 3D mapping during epicardial ablation, and left atrial appendage exclusion as adjunct intraoperative interventions for AF recurrence.

RESULTS: Of the 170 patients, 86.5% had persistent AF and 13.5% had long standing persistent AF. AF-free survival was 87.6% at 1 year, 76.9% at 2 years, 70.4% at 3 years, and 59.3% at four years. AAD use was 87.6% at baseline and reduced to 21%, 20.6%, 18%, 14.1% at year 1, 2, 3, 4 respectively (p-values all <0.01). 3D epicardial mapping showed a significant reduction in combined recurrence 42% vs 25% over 4 years follow-up (p=0.023). Ligament of Marshall and left atrial appendage exclusion showed numerical reduction in AF recurrence from 35% vs 26%, P = 0.49 and 44% vs 30%, P=0.07.

CONCLUSION: The hybrid Convergent procedure reduces AF recurrence and the need for antiarrhythmic medications and while maintaining a good safety profile for the treatment of persistent and long-standing persistent AF.