Combined epicardial and endocardial ablation for atrial fibrillation: Best practices and guide to hybrid convergent procedures. [Review]

MedStar author(s):
Citation: Heart Rhythm. 18(2):303-312, 2021 02.PMID: 33045430Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Atrial Fibrillation/su [Surgery] | *Endocardium/su [Surgery] | *Heart Conduction System/pp [Physiopathology] | *Heart Rate/ph [Physiology] | *Pericardium/su [Surgery] | *Practice Guidelines as Topic | Atrial Fibrillation/pp [Physiopathology] | Catheter Ablation/mt [Methods] | Humans | RecurrenceYear: 2021Local holdings: Available online through MWHC library: 2004 - presentISSN:
  • 1547-5271
Name of journal: Heart rhythmAbstract: 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.All authors: Ahsan S, Blaauw Y, DeLurgio DB, Gauri A, Gill JS, Joshi P, Kaba RA, Lee LS, Lellouche N, Makati KJ, Melichercik J, Sebag FA, Shults CC, Sood N, Steinberg JS, Tondo C, Weerasooriya R, Yang F, Zannis K, Zembala MOOriginally published: Heart Rhythm. 18(2):303-312, 2021 Feb.Fiscal year: FY2021Fiscal year of original publication: FY2021Digital Object Identifier: Date added to catalog: 2021-02-18
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 33045430 Available 33045430

Available online through MWHC library: 2004 - present

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.

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