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

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

A pseudo sinus tachycardia originating from the right superior pulmonary vein. Successful ablation by a simplified, targeted ablation strategy.

We report the case of a young woman suffering from a permanent ectopic atrial tachycardia originating from the right superior pulmonary vein and mimicking a sinus tachycardia on the ECG. Using only 2 quadripolar catheters after a transseptal approach, the focus was successfully mapped to the posterior wall of the right superior pulmonary vein. The focus was successfully ablated during the same procedure using a 4-mm tip-irrigated catheter

Cycle Length Slowing during Mitral Isthmus Ablation

Case ReportsJournal ArticleFLWINinfo:eu-repo/semantics/publishe