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.