Co-Author(s):
karl Crossen, MD
Jaswinder Gill, MD
Christopher Blauth, MD
Saumil Oza, MD
Anthony Magnano, MD
Mark Mostovych, MD
Michael Halkos, MD
Sreedhar Billakanty, MD
Steve Duff, MD
Christopher Stees, MD
Syed Ahsan, MD
John Yap, MD
Eric Espinal, MD
Otto Constantini, MD
David Gilligan, MD
Bruce Hook, MD
Tyler Taigen, MD
David Tschopp, MD
Faraz Kerendi, MD
Christian Shults, MD
Manish Shah, MD
David Pederson, MD
Anil Rajendra, MD
Jose Osorio, MD
Jonathan Silver, MD
Hugh Calkins, MD
Emory St Joseph’s
1364 Clifton Rd, Atlanta, GA
Introduction | Objectives: Long-standing persistent AF (LSPAF) is characterized by
electroanatomical changes to left atrial substrate and clinical success
with endocardial only ablation is limited. The CONVERGE multi-center
randomized controlled trial demonstrated superior effectiveness of
combined epicardial-endocardial (hybrid Convergent, HC) ablation to
endocardial only catheter ablation (CA) for symptomatic, drug
refractory, advanced AF treatment. A sub-analysis was conducted to
compare the outcomes specifically in LSPAF.
Methods: In CONVERGE trial, a total of 153 adult symptomatic drug refractory
patients were randomized to HC (N=102; 38 LSPAF) or CA (N=51; 27 LSPAF).
Primary effectiveness was freedom from atrial arrhythmia through 12
months absent new/increased dose of previously failed anti-arrhythmic
drugs (AADs). Secondary endpoints included freedom from AF, AF burden
reduction, 18-month effectiveness (by 7-day Holter), and quality-of-life
(QoL). Primary safety was major adverse event rate through 30-days post
procedure.
Results: Baseline demographics in the LSPAF subgroup were similar in HC and CA
arms - mean BMI (33 Vs 35), mean LA size (4.5 Vs 4.3 cm), cardioversion
within 12 months (53% Vs 59%), mean AF duration (6.0 Vs 5.9 years).
Mean ablation time in HC was 217 minutes (endocardial = 140 min,
epicardial = 77min) and 181 minutes in CA. As a result of epicardial
ablation, on an average 41 minutes of less endocardial ablation was
required in HC arm. Freedom from atrial arrhythmia was significantly
higher in HC compared to the CA. The QoL and AF symptoms, as assessed by
SF-36 and AFSS questionnaires at baseline and 12 months post-ablation,
significantly improved in HC arm. No deaths or fatal events were
reported in either arm. Three patients (7.8%) in HC and none in CA had
primary safety events.
Conclusions: LSPAF subgroup analysis from the CONVERGE trial showed significant
improvements in freedom from atrial arrhythmias and AF burden reduction
with hybrid Convergent ablation compared to endocardial ablation only,
with quality-of-life benefits. These are important findings as LSPAF
patients currently have limited effective treatment options.