Hybrid Ablation
With such a large population undertreated or with failed treatment for
advanced AF, including long-standing persistent AF, there is still an
unmet need to find better treatment options that provide durable and
long-lasting treatment. Hybrid epicardial-endocardial procedures are
newer, minimally invasive ablation approaches that have shown promising
results compared to endocardial ablation techniques. The development of
hybrid ablation techniques seeks to combine the benefits of both
surgical and electrophysiological catheter ablation in a
multi-disciplinary care team approach, while minimizing the risks that
come with both of those procedures alone. Hybrid procedures target both
the endocardial and epicardial left atrium, seeking to ensure durable,
complete transmural lesions on the beating heart. In order to access the
pericardium without an open chest, access to the posterior left atrium
for epicardial ablation is either gained thoracoscopically or
endoscopically through a subxiphoid incision. The latter approach,
sometimes referred to as the Hybrid Convergent procedure, is the focus
of this review.
Several single center studies have been published describing the
mid-term outcomes of the Hybrid Convergent
procedure.19,20The CONVERGE clinical trial, a multicenter randomized controlled trial
that evaluated the safety of the Hybrid Convergent combined ablation
treatment and its effectiveness versus standard endocardial ablation in
the persistent and long-standing persistent AF patients. Based on these
results, the Hybrid Convergent procedure using the EPi-Sense device
(AtriCure, Inc.) for epicardial ablation augmented by endocardial
catheter ablation is the only FDA-approved minimally invasive treatment
for longstanding persistent AF.