TY  - BOOK
AU  - Shults, Christian
TI  - Combined epicardial and endocardial ablation for atrial fibrillation: Best practices and guide to hybrid convergent procedures. [Review]
SN  - 1547-5271
PY  - 2021///
KW  - *Atrial Fibrillation/su [Surgery]
KW  - *Endocardium/su [Surgery]
KW  - *Heart Conduction System/pp [Physiopathology]
KW  - *Heart Rate/ph [Physiology]
KW  - *Pericardium/su [Surgery]
KW  - *Practice Guidelines as Topic
KW  - Atrial Fibrillation/pp [Physiopathology]
KW  - Catheter Ablation/mt [Methods]
KW  - Humans
KW  - Recurrence
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
N1  - Available online through MWHC library: 2004 - present
N2  - The absence of strategies to consistently and effectively address nonparoxysmal atrial fibrillation by nonpharmacological interventions has represented a long-standing treatment gap. A combined epicardial/endocardial ablation strategy, the hybrid Convergent procedure, was developed in response to this clinical need. A subxiphoid incision is used to access the pericardial space facilitating an epicardial ablation directed at isolation of the posterior wall of the left atrium. This is followed by an endocardial ablation to complete isolation of the pulmonary veins and for additional ablation as needed. Experience gained with the hybrid Convergent procedure during the last decade has led to the development and adoption of strategies to optimize the technique and mitigate risks. Additionally, a surgical and electrophysiology "team" approach including comprehensive training is believed critical to successfully develop the hybrid Convergent program. A recently completed randomized clinical trial indicated that this ablation strategy is superior to an endocardial-only approach for patients with persistent atrial fibrillation. In this review, we propose and describe best practice guidelines for hybrid Convergent ablation on the basis of a combination of published data, author consensus, and expert opinion. A summary of clinical outcomes, emerging evidence, and future perspectives is also given. Copyright (c) 2020 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved
UR  - https://dx.doi.org/10.1016/j.hrthm.2020.10.004
ER  -