Single vs Staged Setting
The Hybrid Convergent procedure relies on procedures performed both by a surgeon and an electrophysiologist. These components can either be done in a single setting in a hybrid OR-electrophysiology lab or separate OR and electrophysiology lab, or in a staged setting with the two stages usually at least 30 days apart. Whether single setting or staged, the epicardial portion is always first, followed by the endocardial portion. A robust comparison of the clinical outcomes of single versus staged Hybrid Convergent procedures has not yet been performed, however the choice may be influenced by physician and patient preferences, institutional practices, and schedule feasibility.
The CONVERGE trial was a multi-center randomized controlled trial to evaluate the safety and effectiveness of Hybrid Convergent versus endocardial catheter ablation in advanced AF.24 With no restrictions on duration of persistent AF at enrollment, this ensured long-standing persistent AF patients were a substantial portion of the enrolled subjects (42%), which no other trial has done to date. The primary endpoint was to determine the freedom from AF/atrial flutter/atrial tachycardia off new or increased dose of previously failed AADs through 12- months. In the Hybrid Convergent group, 67.7% of patients achieved the primary effectiveness endpoint compared to 50.0% in the catheter ablation group, with a significant absolute rate difference of almost 17.7%, favoring Hybrid Convergent (risk ratio=1.35, p=0.036). In various sub-analyses by AAD usage, Hybrid Convergent had a higher success rate than catheter ablation in almost all instances and was deemed clinically although not statistically significant for patients off amiodarone. The Hybrid Convergent arm consistently demonstrated significantly better AF burden reduction and freedom from AF at 12 and 18 months compared to the Catheter Ablation Arm.24