Four-year follow-up of outcomes of the hybrid epicardial-endocardial ablation: A single-center experience

• Published in: Heart rhythm Vol. 21; no. 9; pp. 1555 - 1561
• Main Authors: Kajy, Marvin L., Banno, Joseph, Orey, Stephen, Manandhar, Nabin, Mutete, Diane, McNamara, David A., Loyaga-Rendon, Renzo Y., Albano, Alfred J., Brunner, Michael P., Dahu, Musa I., Dandamudi, Sanjay, Jawad, Wassim I., Willekes, Charles L., Wai Sang, Stephane Leung, Gauri, Andre J., Chalfoun, Nagib T.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2024
• Subjects: Aged; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Catheter Ablation - methods; Convergent; Endocardial ablation; Endocardium - surgery; Epicardial ablation; Female; Follow-Up Studies; Humans; Left atrial appendage exclusion; Ligament of Marshal Ablation; Male; Middle Aged; Pericardium - surgery; Persistent atrial fibrillation; Recurrence; Retrospective Studies; Time Factors; Treatment Outcome; Convergent; Ligament of Marshal Ablation; Epicardial ablation; 3D; AAD; AF; Left atrial appendage exclusion; Endocardial ablation; LAA; Persistent atrial fibrillation
• ISSN: 1547-5271; 1556-3871; 1556-3871
• DOI: 10.1016/j.hrthm.2024.04.012

The CONVERGE trial demonstrated that hybrid epicardial and endocardial ablation was more effective than catheter ablation for the treatment of persistent atrial fibrillation (AF) at 1 year. Long-term real-world outcome data are scarce. We described a single-center experience by evaluating the long-term effectiveness and safety of hybrid epicardial-endocardial ablation. This is a retrospective single-center study. Patients were followed up to 4 years. The primary end point was the rate of AF recurrence up to 4 years postablation. Secondary end points included reduction in antiarrhythmic therapy use, the effect of the ligament of Marshall removal, epicardial posterior wall, 3-dimensional mapping during epicardial ablation, and left atrial appendage exclusion as adjunct intraoperative interventions for AF recurrence. 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 4 years. Antiarrhythmic drug use was 87.6% at baseline and reduced to 21%, 20.6%, 18%, and 14.1% at year 1, 2, 3, and 4, respectively (P < .01 for all). Three-dimensional epicardial mapping showed a significant reduction in combined recurrence from 42% to 25% over 4 years of follow-up (P = .023). Ligament of Marshall and left atrial appendage exclusion showed numerical reduction in AF recurrence from 35% to 26% (P = .49) and from 44% to 30% (P = .07). The hybrid convergent procedure reduces AF recurrence and the need for antiarrhythmic drugs and, while maintaining a good safety profile, for the treatment of persistent and long-standing persistent AF.