PO-02-077 HYBRID CONVERGENT PROCEDURE FOR THE TREATMENT OF PERSISTENT AND LONG-STANDING PERSISTENT ATRIAL FIBRILLATION: A SINGLE CENTER EXPERIENCE

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Pulmonary vein isolation by endocardial ablation is an effective treatment strategy for paroxysmal atrial fibrillation (AF). However, its effectiveness for treatment of persistent forms of AF is limited. In patients with advanced AF, there are extra-pulmonary vein foci that initiate and perpetuate AF. The left atrial posterior wall has been shown to have the highest proportion of such triggers. The Hybrid Convergent procedure is a novel procedure that combines epicardial and endocardial ablation to obtain isolation of the left atrial posterior wall and pulmonary veins. There is paucity of real world and long-term outcomes data regarding the Hybrid Convergent procedure. The purpose of this study is to describe the outcomes of Hybrid Convergent procedures for treatment of persistent and long standing persistent atrial fibrillation at 1 and 3 year follow up. A retrospective review of prospectively maintained single center Hybrid Convergent database was performed. Demographics, clinical, procedural, and outcomes data were collected on all patients. Atrial fibrillation burden was tracked using ECGs, wearable monitors, ICDs/pacemakers, implantable recorders and Holter monitors. Fifty patients with persistent and long-standing persistent AF underwent Hybrid Convergent procedure (age 62.6 ±9.1; male: 78%). Prior to ablation, the mean number of failed antiarrhythmic drugs was 2.3, mean number of previous ablations was 1.7, and mean left atrial volume index was 47.5 ± 17.9 ml/m2. 29 of 41 (71%) patients were free from AF recurrence at one year and 16 of 32 (50%) were free from AF at 3 years. The mean pre-operative AF burden for the group was 65.6 ± 40.2% on antiarrhythmics. Postoperatively, the total AF burden at 1 and 3 years were 23. 8 ± 40.9%, and 27.9 ± 41.1%, respectively. The Hybrid Convergent procedure is effective for the treatment of persistent and long-standing persistent AF with a 1- and 3-year freedom from AF recurrence of 71% and 50%, respectively. In this patient population, this procedure was able to reduce the mean burden of AF by 63.7% (41.8% absolute) at 1 year and by 57.4% (37.7% absolute) at 3 years. Our single center experience is consistent with the success rate from the Converge randomized trial at one year and provides additional 3 year follow up data.