Abstract 11684: Meta-Analysis of Contemporary Hybrid Convergent Ablation Outcomes

Introduction: Recent randomized clinical trial data demonstrated safety and effectiveness of hybrid epicardial-endocardial (convergent) ablation for persistent and longstanding persistent atrial fibrillation (PersAF/LSPAF). The objective of this study was to perform a systematic review and meta-analysis focused on contemporary hybrid convergent procedure outcomes. Methods: Predefined search terms were used in PubMed/EMBASE in May 2021. Abstracts and full text in English were reviewed for peer-reviewed, primary clinical studies of hybrid convergent procedures in PersAF/LSPAF using the current unipolar device for epicardial ablation and lesion set focused on left atrial posterior wall and pulmonary vein isolation. Meta-analysis was performed with using a random effects model with a restricted maximum likelihood estimator and forest plots. Heterogeneity was tested using Cochran’s Q-test. Results: The updated search yielded 155 unique results. Two articles from manual searching were added. Twenty-seven full text articles were assessed for inclusion. Six articles that included 551 patients were identified for qualitative and quantitative analysis. Ninety-six percent of patients had persistent or long-standing persistent AF. Mean/median pre-operative AF duration ranged from 2 to 5 years. The 30-day major adverse event rate was 6% (95% CI 3-8%, n=551, 6 studies). No atrioesophageal fistulas or periprocedural mortality events were reported. Freedom from atrial arrhythmia at one year or later was 69% (95% CI 61-78%; n=523, 6 studies) regardless of anti-arrhythmic drugs (AADs) and 50% (95% CI 42-58%; n=343; 3 studies) off AADs. Heterogeneity was insignificant for effectiveness off AADs (p=0.14) and safety (p=0.23) Conclusions: This meta-analysis found favorable effectiveness of contemporary hybrid convergent procedures at one year, even off AADs, and a reasonable safety profile in mostly persistent or long-standing persistent AF.