In a meta-analysis published in the Journal of Cardiothoracic Surgery, researchers compared the safety and efficacy of hybrid convergent ablation (HCA) and endocardial catheter ablation (ECA) in patients with atrial fibrillation. Overall, they reported that HCA was associated with a significantly greater rate of freedom from atrial fibrillation (FFAF) compared to ECA. However, HCA was also associated with an increased rate of post-procedure complications.

This review included a total of four randomized controlled trials with a pool of 233 patients undergoing HCA and 189 patients undergoing ECA only. The primary measure of the analysis was FFAF at final follow-up, while additional outcomes included mortality and serious complications.

Specifically, the authors reported that HCA groups had significantly increased FFAF compared to the ECA group (odds ratio [OR], 2.78; 95% confidence interval [CI], 1.82-4.24; P<.01; I2=0). Major post-procedural complications were significantly more frequent in the HCA group (OR, 5.14; 95% CI, 1.70-15.54; P<.01).

The authors noted the strength of their findings was limited by the small number of trials which met the inclusion criteria, leading to a small population for analyses. Additionally, post-procedure rhythm monitoring and the definition of FFAF were different between the studies.

Ultimately, the study’s authors supported the HCA strategy of a subxiphoid, surgical ablation and subsequent endocardial ablation. They called for future randomized controlled trials to validate their findings in larger cohorts.

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