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

Autor:	Makati KJ; Department of Medicine, BayCare Health Systems/University of South Florida, Tampa, Florida., Sood N; Cardiac Arrhythmia Services, Southcoast Health System, Fall Rivers, Massachusetts., Lee LS; Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, Indiana., Yang F; Department of Cardiology, Maimonides Medical Center, Brooklyn, New York., Shults CC; Department of Cardiac Surgery, Medstar Washington Hospital Center, Washington, District of Columbia., DeLurgio DB; Division of Cardiology, Emory St. Joseph's Hospital, Atlanta, Georgia., Melichercik J; Clinic of Internal Medicine and Cardiology, MediClin Herzzentrum Lahr/Baden, Lahr, Germany., Gill JS; Department of Cardiology, Guy's and St. Thomas' NHS Trust, London, United Kingdom., Kaba RA; Department of Cardiology and Cardiac Surgery, St George's University Hospitals NHS Foundation Trust, London, United Kingdom; Department of Cardiology, Ashford and St Peter's NHS Foundation Trust, Chertsey, United Kingdom., Ahsan S; Heart Center, St. Bartholomew's Hospital, London, United Kingdom., Weerasooriya R; Department of Cardiology, University of Western Australia, Mount Hospital and Hollywood Private Hospital, Nedlands, Western Australia, Australia., Joshi P; Department of Cardiology, University of Western Australia, Mount Hospital and Hollywood Private Hospital, Nedlands, Western Australia, Australia., Lellouche N; Department of Cardiology, Hôpital Henri-Mondor, Creteil, France., Blaauw Y; Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands., Zannis K; Unit of Cardiac Surgery and Department of Cardiology, Institut Mutualiste Montsouris, Paris, France., Sebag FA; Unit of Cardiac Surgery and Department of Cardiology, Institut Mutualiste Montsouris, Paris, France., Gauri A; Department of Cardiology, Spectrum Health, Grand Rapids, Michigan., Zembala MO; Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Zabrze, Poland., Tondo C; Heart Rhythm Center, Monzino Cardiac Center, Milan, Italy., Steinberg JS; Clinical Cardiovascular Research Center, University of Rochester School of Medicine & Dentistry, Rochester, New York; Department of Cardiology, Hackensack Meridian School of Medicine, Nutley, New Jersey. Electronic address: jsteinberg@smgnj.com.
Jazyk:	angličtina
Zdroj:	Heart rhythm [Heart Rhythm] 2021 Feb; Vol. 18 (2), pp. 303-312. Date of Electronic Publication: 2020 Oct 09.
DOI:	10.1016/j.hrthm.2020.10.004
Abstrakt:	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. (Copyright © 2020 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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