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. 2024 Jul;10(7 Pt 2):1700-1710.
doi: 10.1016/j.jacep.2024.05.029.

Hybrid-Convergent Procedure or Pulsed Field Ablation in Long-Standing Persistent Atrial Fibrillation

Lorenzo Bianchini  1 , Marco Schiavone  2 , Giulia Vettor  1 , Alessio Gasperetti  3 , Eleonora Penza  4 , Andrea Ballotta  5 , Sergio Pirola  4 , Claudio Brambillasca  5 , Elio Zito  6 , Francesca De Lio  1 , Nicoletta Ventrella  6 , Fabrizio Tundo  1 , Massimo Moltrasio  1 , Gaetano Fassini  1 , Gianluca Polvani  7 , Claudio Tondo  8
Affiliations
Free article

Hybrid-Convergent Procedure or Pulsed Field Ablation in Long-Standing Persistent Atrial Fibrillation

Lorenzo Bianchini et al. JACC Clin Electrophysiol. 2024 Jul.
Free article

Abstract

Background: Hybrid-convergent radiofrequency (RF) ablation targeting pulmonary veins (PVs) and left atrial posterior wall (LAPW) has shown better arrhythmic outcomes than an endocardial-only RF strategy, despite higher rates of complications. Comparisons with extensive pulsed field ablation (PFA) are currently lacking.

Objectives: This study aimed to compare the efficacy and safety of the hybrid-convergent RF vs PFA of PVs and LAPW in long-standing persistent atrial fibrillation (LSPAF).

Methods: Ninety-three consecutive LSPAF patients, treated with 2-step hybrid-convergent RF ablation (hybrid group, n = 49) or with PFA of PVs and LAPW (PFA group, n = 44) were enrolled. Primary efficacy endpoint was defined as any atrial tachyarrhythmias (ATA) recurrence after the 3-month blanking period, over a follow-up time of 12 months. Periprocedural adverse events and late complications during follow-up were deemed primary safety outcomes.

Results: The hybrid and PFA groups had similar baseline characteristics; mean age was hybrid 63.8 ± 10.6 years vs PFA 66.0 ± 7.4 years; P = 0.105. PV and LAPW ablation were acutely successful in all patients. Step 1 hybrid-epicardial procedures were longer than PFA (166 [Q1-Q3: 140-205] minutes vs 107.5 [Q1-Q3: 82.5-12] minutes; P < 0.01). At 12-month follow-up, there was no difference in ATA recurrences between groups (hybrid 36.7% vs PFA 40.9%; P = 0.680; log-rank at survival analysis P = 0.539). After adjusting for confounders, a larger left atrial volume and recurrences during the blanking-period were predictors of ATA recurrences after ablation, regardless of procedural technique employed. PFA showed a better safety profile with a lower rate of major periprocedural complications compared with hybrid ablation (12% vs 0%; P = 0.028).

Conclusions: Hybrid-convergent and PFA share comparable arrhythmic outcomes in LSPAF, but hybrid-convergent ablation carries higher periprocedural risks.

Keywords: atrial fibrillation; hybrid convergent ablation; long-standing persistent AF; posterior wall; pulsed field ablation.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Tondo serves a member of scientific advisory boards for Medtronic Inc and Boston Scientific; and receives lecture/proctoring fees from Abbott Medical, AtriCure, Boston Scientific, and Medtronic Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.