A Chronicle of Hybrid Atrial Fibrillation Ablation Therapy: From Cox Maze to Convergent

Overview

Journal Arrhythm Electrophysiol Rev

Date 2022 Jul 18

PMID 35846422

Authors

Riyaz A Kaba

Omar Ahmed

Elijah Behr

Aziz Momin

Affiliations

Soon will be listed here.

Abstract

The burden of AF is increasing in prevalence and healthcare resource usage in the UK and worldwide. It can result in impaired quality of life for affected patients, as well as increased risk of stroke, heart failure and mortality. A holistic, integrated approach to AF management is recommended, which may include a focus on reducing risk factors and on medical management with anticoagulation and anti-arrhythmic drugs. There are also various ablation strategies that may be considered when anti-arrhythmic drugs fail to alleviate symptoms and reduce AF burden. These ablation techniques range from standalone percutaneous endocardial catheter ablation to open surgical ablation procedures concomitant with cardiac surgery. More recently, hybrid ablation that combines aspects of both surgical and electrophysiologically targeted ablation has been described. This article reviews the evolution of ablation strategies, beginning with the origin of the Cox maze IV procedure and continuing to the recent hybrid convergent approach, and provides a summary of the associated outcomes.

References

Turagam M, Musikantow D, Whang W, Koruth J, Miller M, Langan M . Assessment of Catheter Ablation or Antiarrhythmic Drugs for First-line Therapy of Atrial Fibrillation: A Meta-analysis of Randomized Clinical Trials. JAMA Cardiol. 2021; 6(6):697-705. PMC: 8082432. DOI: 10.1001/jamacardio.2021.0852. View

Khiabani A, MacGregor R, Bakir N, Manghelli J, Sinn L, Maniar H . The long-term outcomes and durability of the Cox-Maze IV procedure for atrial fibrillation. J Thorac Cardiovasc Surg. 2020; 163(2):629-641.e7. PMC: 9810144. DOI: 10.1016/j.jtcvs.2020.04.100. View

Tonks R, Lantz G, Mahlow J, Hirsh J, Lee L . Short and Intermediate Term Outcomes of the Convergent Procedure: Initial Experience in a Tertiary Referral Center. Ann Thorac Cardiovasc Surg. 2019; 26(1):13-21. PMC: 7046930. DOI: 10.5761/atcs.oa.19-00164. View

Kiser A, Wimmer-Greinecker G, Chitwood W . Totally extracardiac Maze procedure performed on the beating heart. Ann Thorac Surg. 2007; 84(5):1783-5. DOI: 10.1016/j.athoracsur.2007.08.027. View

Zembala M, Filipiak K, Kowalski O, Buchta P, Niklewski T, Nadziakiewicz P . Staged hybrid ablation for persistent and longstanding persistent atrial fibrillation effectively restores sinus rhythm in long-term observation. Arch Med Sci. 2017; 13(1):109-117. PMC: 5206354. DOI: 10.5114/aoms.2015.53960. View

DeLurgio D, Gill J, Ahsan S, Kaba R, Plasseraud K, Halkos M . Hybrid Convergent Procedure for the Treatment of Persistent and Long-standing Persistent Atrial Fibrillation. Arrhythm Electrophysiol Rev. 2021; 10(3):198-204. PMC: 8576514. DOI: 10.15420/aer.2021.24. View

Kiser A, Cockfield W . Paracardioscopic ex-maze procedure for atrial fibrillation. Multimed Man Cardiothorac Surg. 2014; 2010(201):mmcts.2008.003863. DOI: 10.1510/mmcts.2008.003863. View

Gulkarov I, Wong B, Kowalski M, Worku B, Afzal A, Ivanov A . Convergent ablation for persistent atrial fibrillation: Single center experience. J Card Surg. 2019; 34(10):1037-1043. DOI: 10.1111/jocs.14204. View

. Abstracts from the 26th Annual International Atrial Fibrillation Symposium. J Cardiovasc Electrophysiol. 2021; 32(5):1467-1515. DOI: 10.1111/jce.14975. View

10.

Wilber D, Pappone C, Neuzil P, de Paola A, Marchlinski F, Natale A . Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial. JAMA. 2010; 303(4):333-40. DOI: 10.1001/jama.2009.2029. View

11.

Badhwar V, Rankin J, Damiano Jr R, Gillinov A, Bakaeen F, Edgerton J . The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation. Ann Thorac Surg. 2016; 103(1):329-341. DOI: 10.1016/j.athoracsur.2016.10.076. View

12.

Whitlock R, Belley-Cote E, Paparella D, Healey J, Brady K, Sharma M . Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke. N Engl J Med. 2021; 384(22):2081-2091. DOI: 10.1056/NEJMoa2101897. View

13.

van der Heijden C, Vroomen M, Luermans J, Vos R, Crijns H, Gelsomino S . Hybrid versus catheter ablation in patients with persistent and longstanding persistent atrial fibrillation: a systematic review and meta-analysis†. Eur J Cardiothorac Surg. 2019; 56(3):433-443. DOI: 10.1093/ejcts/ezy475. View

14.

Wazni O, Dandamudi G, Sood N, Hoyt R, Tyler J, Durrani S . Cryoballoon Ablation as Initial Therapy for Atrial Fibrillation. N Engl J Med. 2020; 384(4):316-324. DOI: 10.1056/NEJMoa2029554. View

15.

Yilmaz A, Van Putte B, van Boven W . Completely thoracoscopic bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation. J Thorac Cardiovasc Surg. 2008; 136(2):521-2. DOI: 10.1016/j.jtcvs.2008.01.035. View

16.

Mahapatra S, LaPar D, Kamath S, Payne J, Bilchick K, Mangrum J . Initial experience of sequential surgical epicardial-catheter endocardial ablation for persistent and long-standing persistent atrial fibrillation with long-term follow-up. Ann Thorac Surg. 2011; 91(6):1890-8. PMC: 3117201. DOI: 10.1016/j.athoracsur.2011.02.045. View

17.

Della Rocca D, Tarantino N, Trivedi C, Mohanty S, Anannab A, Salwan A . Non-pulmonary vein triggers in nonparoxysmal atrial fibrillation: Implications of pathophysiology for catheter ablation. J Cardiovasc Electrophysiol. 2020; 31(8):2154-2167. DOI: 10.1111/jce.14638. View

18.

Kuniss M, Pavlovic N, Velagic V, Hermida J, Healey S, Arena G . Cryoballoon ablation vs. antiarrhythmic drugs: first-line therapy for patients with paroxysmal atrial fibrillation. Europace. 2021; 23(7):1033-1041. PMC: 8286851. DOI: 10.1093/europace/euab029. View

19.

Je H, Shuman D, Ad N . A systematic review of minimally invasive surgical treatment for atrial fibrillation: a comparison of the Cox-Maze procedure, beating-heart epicardial ablation, and the hybrid procedure on safety and efficacy. Eur J Cardiothorac Surg. 2015; 48(4):531-40. DOI: 10.1093/ejcts/ezu536. View

20.

van Laar C, Geuzebroek G, Hofman F, van Putte B . The totally thoracoscopic left atrial maze procedure for the treatment of atrial fibrillation. Multimed Man Cardiothorac Surg. 2016; 2016. DOI: 10.1093/mmcts/mmv043. View