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Combined epicardial and endocardial ablation for atrial fibrillation: Best practices and guide to hybrid convergent procedures.

Abstract：

:The absence of strategies to consistently and effectively address nonparoxysmal atrial fibrillation by nonpharmacological interventions has represented a long-standing treatment gap. A combined epicardial/endocardial ablation strategy, the hybrid Convergent procedure, was developed in response to this clinical need. A subxiphoid incision is used to access the pericardial space facilitating an epicardial ablation directed at isolation of the posterior wall of the left atrium. This is followed by an endocardial ablation to complete isolation of the pulmonary veins and for additional ablation as needed. Experience gained with the hybrid Convergent procedure during the last decade has led to the development and adoption of strategies to optimize the technique and mitigate risks. Additionally, a surgical and electrophysiology "team" approach including comprehensive training is believed critical to successfully develop the hybrid Convergent program. A recently completed randomized clinical trial indicated that this ablation strategy is superior to an endocardial-only approach for patients with persistent atrial fibrillation. In this review, we propose and describe best practice guidelines for hybrid Convergent ablation on the basis of a combination of published data, author consensus, and expert opinion. A summary of clinical outcomes, emerging evidence, and future perspectives is also given.

journal_name

Heart Rhythm

journal_title

Heart rhythm

authors

Makati KJ,Sood N,Lee LS,Yang F,Shults CC,DeLurgio DB,Melichercik J,Gill JS,Kaba RA,Ahsan S,Weerasooriya R,Joshi P,Lellouche N,Blaauw Y,Zannis K,Sebag FA,Gauri A,Zembala MO,Tondo C,Steinberg JS

doi

10.1016/j.hrthm.2020.10.004

subject

Has Abstract

pub_date

2020-10-09 00:00:00

eissn

1547-5271

issn

1556-3871

pii

S1547-5271(20)30945-0

pub_type

杂志文章

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