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