Efficacy and safety of hybrid convergent procedure vs endocardial catheter ablation for the management of atrial fibrillation. (24th May 2021)

• Record Type: Journal Article
• Authors: Abdul Razzack, A; Rahman, S; Pasam, T; Pasam, C; Saeed, T; Khokhar, HT; Pothuru, S; Adeel Hassan, S; Mandava, S; Theja Reddy, K; Kumar, R; Kumar, S; Sattar, Y
• Is Part Of: Europace. Volume 23:Supplement 3(2021)
• Publication Date: 2021-05-24
• Subjects: Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euab116.263
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Funding Acknowledgements: Type of funding sources: None. Background- Little is known regarding the efficacy and safety of hybrid convergent epicardial and endocardial approach (CVP) that has emerged as an alternative to endocardial catheter ablation (CA) for the management of persistent and paroxysmal atrial fibrillation. Methods-Electronic databases ( PubMed, Embase, Scopus) were searched from inception to Jan 6th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p < 0.05. The primary outcome of interest was recurrence of atrial tachyarrhythmia {Atrial fibrillation (AF)/Atrial flutter(AFL) /Atrial tachycardia(AT)} Secondary outcomes included any intervention (DC Cardioversion (DCCV), repeat ablation) and major adverse events (MAE). Results- A total of three studies with 336 (CVP = 190, CA = 146) participants were included. CVP was associated with significantly higher freedom from atrial tachyarrhythmia recurrence compared with CA therapy (RR 0.60, 95% CI 0.45-0.78; p = 0.0002; I2 = 0). Patients receiving CVP had lower odds of requiring any re-intervention (DCCV, repeat ablation) when compared to CA therapy (RR 4.11, 95% CI 1.17-14.46; p = 0.03; I2 = 0). However, CVP was associated with significantly higher rate of major adverse events (RR 0.44, 95% CI 0.30-0.65; p= <0.0001; I2 = 0). Conclusion-Treatment with Hybrid convergent ablation seems to be superior than endocardial catheter ablation for prevention of arrhythmia recurrence but may also cause more severe adverse effects.