Co-Author(s):
Christopher Zambrano, MD - Southcoast Health System
Andrew Sherman, MD - Tampa Cardiac Specialists
Kevin Makati, MD - Tampa Cardiac Specialists
Southcoast Health System
363 Highland AVE, Fall River, MA 02127
Introduction | Objectives: : In long-standing persistent AF (LSPAF) patients, sustenance of AF is
mediated by extra pulmonary vein (PV) drivers. Left atrial posterior
wall is a desirable target however the results with endocardial ablation
alone are limited due to challenges of achieving transmural lesions
while maintaining safety. Combined endocardial and epicardial ablation
may provide improved outcomes.
Methods: : A total of 105 consecutive symptomatic drug refractory LSPAF patients
underwent hybrid procedure with EPi-Sense RF device for epicardial PV
and posterior wall ablation and cryoballoon for endocardial PV
isolation. A right sided cavo-tricuspid isthmus line was created with
endocardial RF. The freedom from AF/AFL/AT was assessed through 12mo and
18mo using Kaplan-Meier analysis. In patients who received continuous
monitoring (62% with holter/implantable devices), residual AF burden
reduction was assessed
Results: The mean AF duration was 4.9 years, 71% had previous cardioversion and
55% failed catheter ablation. The effectiveness results are summarized
in the table below. No deaths, atrioesophageal fistula, stroke, or
cardiac perforation occurred. Four patients (3.8%) experienced
pericardial effusions, 1 (1%) had excessive bleeding and 1 (1%) had
volume overload.
Conclusions: Hybrid Convergent procedure is safe and effective for the treatment of
long-standing persistent AF patients who currently do not have an FDA
approved alternative
AFS 2021-20