Abstract 4138840: Hybrid Convergent Procedure as a ‘Bail Out’ Strategy In Patients with Atrial Fibrillation Resistant To Catheter Ablation

Introduction: Atrial fibrillation (AF) is a common and symptomatic arrhythmia which can be resistant to conventional endocardial catheter ablation. The Hybrid Convergent procedure, combining initial surgical AF ablation with a concurrent or staged endocardial catheter-based component, offers a potential solution for refractory cases. While effective as a de novo treatment for persistent AF, outcomes of this procedure in patients who failed prior catheter ablation remains uncertain. Our aim was to evaluate its efficacy and safety in this patient group. Methods: We conducted a single-center retrospective cohort study involving consecutive patients selected for the Hybrid Convergent procedure between May 2019 and October 2022 at a single center in Perth, Western Australia. Eligible patients had symptomatic AF and failed prior catheter ablation and antiarrhythmic drugs. The primary outcome was single procedure freedom from atrial arrhythmias, on or off antiarrhythmic drugs at 12 months. Overall follow-up freedom from AF, 12-month AF burden, complications and reinterventions were also recorded. Results: Sixty-two patients underwent both stages of the Hybrid Convergent procedure. All received concomitant thoracoscopic left atrial appendage exclusion. Of these, 46 (74.2%) were male, 27 (45.3%) had paroxysmal AF, and 15 (24.2%) had implantable loop recorders (ILRs). The mean duration since AF diagnosis was 9.5±7.1 years, with a median of 3 prior catheter ablations for AF. The median follow-up was 25.9 (13-48) months. After 12 months, 36 (62.9%) patients remained free from any atrial arrhythmia (figure 1). At this time point, 47 (75.8%) patients had an atrial arrhythmia burden of less than 5%. For the overall follow-up period, 32 (51.6%) patients maintained freedom from any atrial arrhythmia. Among patients with ILRs, the 12 month atrial arrhythmia free survival was 36.6%, compared with 64.4% in those without ILRs. Nine patients required repeat catheter ablation. There was one major complication. Conclusions: Our initial experience with the Hybrid Convergent procedure demonstrates sustained effectiveness and safety for patients with paroxysmal or persistent AF who have previously failed catheter ablation strategies.