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