Catheter ablation of atrial fibrillation (AF) has been shown to be effective for paroxysmal AF. However, for patients with persistent or longstanding persistent AF, the success rates for catheter ablation is low. The Cox-Maze procedure is the most effective non-pharmacological treatment of AF. However, due to the need for open-heart surgery and the morbidity associated with the surgical Cox-Maze procedure, minimally invasive and epicardial-endocardial (hybrid) ablation procedures have been developed. This article will review the main surgical and hybrid approaches used for the treatment of persistent and long-standing persistent AF.
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Four-year follow-up of outcomes of the hybrid epicardial-endocardial ablation: A single-center experience.
Heart Rhythm
September 2024
Corewell Health West, Fred and Lena Meijer Heart Center, Grand Rapids, Michigan; Michigan State University College of Human Medicine, Grand Rapids, Michigan.
Background: 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.
Objective: We described a single-center experience by evaluating the long-term effectiveness and safety of hybrid epicardial-endocardial ablation.
Efficacy and safety of hybrid epicardial and endocardial ablation versus endocardial ablation in patients with persistent and longstanding persistent atrial fibrillation: a randomised, controlled trial.
EClinicalMedicine
July 2023
National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland.
Article Synopsis
- The study compares the effectiveness of hybrid epicardial-endocardial ablation (HA) to standard endocardial catheter ablation (CA) for patients with persistent and longstanding persistent atrial fibrillation (PersAF/LSPAF), suggesting HA may offer better long-term results.
- The CEASE-AF trial enrolled participants across nine European countries, focusing on those with symptomatic, drug-resistant atrial fibrillation and specific heart size measurements, making it a randomized controlled study.
- Results showed that 71.6% of patients in the HA group achieved freedom from significant arrhythmias after 12 months, compared to only 39.2% in the CA group, indicating a substantial improvement in effectiveness with HA.
Hybrid epicardial-endocardial ablation for long-standing persistent atrial fibrillation: A subanalysis of the CONVERGE Trial.
Heart Rhythm O2
February 2023
Guy's and St. Thomas' Foundation Trust, London, United Kingdom.
Background: Favorable clinical outcomes are difficult to achieve in long-standing persistent atrial fibrillation (LSPAF) with catheter ablation (CA). The CONVERGE (Convergence of Epicardial and Endocardial Ablation for the Treatment of Symptomatic Persistent Atrial FIbrillation) trial evaluated the effectiveness of hybrid convergent (HC) ablation vs endocardial CA.
Objective: The study sought to evaluate the safety and effectiveness of HC vs CA in the LSPAF subgroup from the CONVERGE trial.
Hybrid Convergent Procedure for the Treatment of Persistent and Long-standing Persistent Atrial Fibrillation.
Arrhythm Electrophysiol Rev
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Emory St Joseph's Hospital, Atlanta, GA, US.
Recent advances have been made in AF treatment, including the role of early rhythm control and landmark clinical trials using ablation therapy. However, some treatment gaps remain, including the creation of durable lesions outside the pulmonary veins and effective treatment of longstanding persistent AF. A novel epicardial-endocardial ablation approach - the hybrid convergent procedure - was developed to combine surgical and catheter ablation techniques into a collaborative, multidisciplinary approach to managing AF.
View Article and Find Full Text PDFRecent clinical trials in atrial fibrillation.
Curr Opin Cardiol
November 2021
Division of Electrophysiology, Department of Cardiology, Department of Medicine, Houston Methodist Debakey, Houston, Texas, USA.
Purpose Of Review: Management of atrial fibrillation can be overwhelming with the amount of information and treatment options available today. This review discusses landmark and other clinically relevant trials published in the last 18 months.
Recent Findings: There have been several recent key clinical trials and subanalyses in the field of atrial fibrillation.
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