The Sickest Afib Patients Get the Least Effective Treatment

How Hybrid AF Therapy breaks the cycle when medications fail and catheter ablation isn't enough

For patients who have long-standing persistent atrial fibrillation (LSPAF)—but who are not expected to have cardiac surgery in the near term—look to Hybrid AF™ Therapy. Hybrid AF Therapy, a Class II recommendation,¹ is a combination of catheter ablation and minimally invasive epicardial surgical ablation.

Patients are commonly managed by primary care physicians or cardiologists who may not routinely refer them to electrophysiology (EP)—especially when symptoms are less severe or controlled by medication. Those medications, though, can’t halt Afib progression.

Know Your Afib Patients’ Trajectory

LSPAF patients have often experienced failed endocardial catheter ablation(s).
At this advanced stage of Afib, they also have:

• An enlarged left atrium
• A scarred left atrial posterior wall
• Comorbidities, such as heart failure

Those patients need an effective, society-recommended therapy to improve their symptoms and quality of life.

Sinus Rhythm: the Standard of Care for Advanced Afib Patients

Hybrid AF Therapy is the best option to get Advanced LSPAF patients—without structural heart disease—back into sinus rhythm. However, very few such patients are referred to an electrophysiologist for intervention.

Fewer than 3x of Afib patients are referred to EP.^2-3

“We need to add not just years to life, but life to those years.” 

– C. Michael Gibson M.A. (Hon.), M.D., FRCP, FAHA, FSCAI, FACC

Breaking the Afib Spiral: Referring to Electrophysiology Sooner

Patients with Advanced Afib should be referred earlier than they commonly are to EP. Endocardial catheter ablation alone is not indicated for these patients. However, Hybrid AF Therapy is an “advise to do” Class II recommendation from the Heart Rhythm Society¹— making it a logical step to have patients assessed by EP.

Benefit of Hybrid AF Therapy Ablation

Catheter ablation is often effective at freeing paroxysmal patients from Afib. But once Afib progresses, medications are not curative. Hybrid AF Therapy ablation is the only proven minimally invasive procedure to treat this patient population. Note the data about Hybrid AF Therapy ablation—the procedure confers the following benefits:

Up to

88%

freedom of atrial arrhythmias

Up to

94%

Reduction in Afib burden to ≤5% ^19-21

More than

3x

improvement in Afib symptoms ²²

More than

2x

improvement in QOL scores ²¹

2x

More likely to no longer need medications for Afib ²³

Early intervention is critical to halt Afib and heart failure. And recent consensus guidelines from the following societies state that treatment with an ablation strategy can reduce Afib burden.¹

Hybrid AF Therapy Ablation—A Two-Stage Procedure

This minimally invasive surgery (MIS), which mimics the Cox-Maze procedure, combines epicardial and endocardial ablation in a two-stage process:

• Stage 1: MIS epicardial ablation + left atrial appendage exclusion
• Stage 2: Endocardial mapping and ablation

Medical management—to treat rate and rhythm—is often used to treat Afib.  But once Afib progresses, despite medical management, the best chance to free the patient from Afib is with Hybrid AF Therapy ablation.

Related Articles

Society Guidelines–Directed Care for Afib

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References:

1. Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., ... & Van Wagoner, D. R. (2024). 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology, 83(1), 109-279.
2. Levy, S., Breithardt, G., Campbell, R. W. F., Camm, A. J., Daubert, J. C., Allessie, M., ... & Lüderitz, B. (1998). Atrial fibrillation: current knowledge and recommendations for management. European heart journal, 19(9), 1294-1320.
3. Borg Xuereb, C. (2014). Patients’ and physicians’ experiences of atrial fibrillation and anticoagulation therapy: a qualitative journey (Doctoral dissertation, Aston University).
4. DeLurgio, D. B., Crossen, K. J., Gill, J., Blauth, C., Oza, S. R., Magnano, A. R., ... & Calkins, H. (2020). Hybrid convergent procedure for the treatment of persistent and long-standing persistent atrial fibrillation: results of CONVERGE clinical trial. Circulation: Arrhythmia and Electrophysiology, 13(12), e009288.
5. Tahirkheli, M., Ahmad, A., Amjad, Q. M., Muzaffar, B., Hameed, H., Batool, S., ... & Ali, M. (2023). SINGLE CENTER CLINICAL EXPERIENCE WITH HYBRID CONVERGENT ABLATION AND IMPACT ON ATRIAL FIBRILLATION BURDEN AS DETERMINED BY CARDIAC RHYTHM MANAGEMENT DEVICES. Journal of the American College of Cardiology, 81(8_Supplement), 74-74.
6. Kajy, M. L., Banno, J., Orey, S., Manandhar, N., Mutete, D., McNamara, D. A., ... & Chalfoun, N. T. (2024). Four-year follow-up of outcomes of the hybrid epicardial-endocardial ablation: A single-center experience. Heart Rhythm, 21(9), 1555-1561.
7. Geršak, B., & Jan, M. (2016). Long-term success for the convergent atrial fibrillation procedure: 4-year outcomes. The Annals of thoracic surgery, 102(5), 1550-1557. 
   Makati, K. J., Sherman, A. J.,
8. Gerogiannis, I., & Sood, N. (2020). Safety and efficacy of convergent hybrid procedure using cryo as endocardial energy source for the treatment of atrial fibrillation. Circulation: Arrhythmia and Electrophysiology, 13(11), e008556.
9. Larson, J., Merchant, F. M., Patel, A., Ndubisi, N. M., Patel, A. M., DeLurgio, D. B., ... & Westerman, S. (2020). Outcomes of convergent atrial fibrillation ablation with continuous rhythm monitoring. Journal of Cardiovascular Electrophysiology, 31(6), 1270-1276.
10. Maclean, E., Yap, J., Saberwal, B., Kolvekar, S., Lim, W., Wijesuriya, N., ... & Ahsan, S. (2020). The convergent procedure versus catheter ablation alone in longstanding persistent atrial fibrillation: a single centre, propensity-matched cohort study. International Journal of Cardiology, 303, 49-53.
11. Gegechkori, N., Yang, F., Jacobowitz, I., & Greenberg, Y. (2022). The effect of left atrial appendage closure on patients undergoing hybrid/convergent atrial fibrillation ablation. J Atr Fibrillation Electrophysiol, 15(4), 66-71.
12. Mannakkara, N. N., Porter, B., Child, N., Sidhu, B. S., Mehta, V. S., Elliott, M. K., ... & Gill, J. S. (2023). Convergent ablation for persistent atrial fibrillation: outcomes from a single-centre real-world experience. European Journal of Cardio-Thoracic Surgery, 63(1), ezac515.
13. Diab, M., NAND, N., Chuprun, D., Shah, A. H., Karki, R., & Rao, M. (2023). PO-02-097 THE OUTCOMES OF CONVERGENT PROCEDURE IN PATIENTS WITH PRIOR ATRIAL FIBRILLATION ABLATION: A SINGLE CENTER EXPERIENCE. Heart Rhythm, 20(5), S348.
14. Tonks, R., Lantz, G., Mahlow, J., Hirsh, J., & Lee, L. S. (2020). Short and intermediate term outcomes of the convergent procedure: initial experience in a tertiary referral center. Annals of Thoracic and Cardiovascular Surgery, 26(1), 13-21.
15. Gulkarov, I., Wong, B., Kowalski, M., Worku, B., Afzal, A., Ivanov, A., ... & Reddy, B. (2019). Convergent ablation for persistent atrial fibrillation: single center experience. Journal of Cardiac Surgery, 34(10), 1037-1043.
16. Gill, J., Crossen, K. J., Blauth, C., Kerendi, F., Oza, S. R., Magnano, A. R., ... & De Lurgio, D. B. (2023). Atrial fibrillation symptom reduction and improved quality of life following the hybrid convergent procedure: A CONVERGE trial subanalysis. Annals of Cardiothoracic Surgery, 13(2), 155.
17. Pickmans, F., Sherman, S., Sherman, A., & Makati, K. J. (2022). Ten Year Performance of Convergent 
    Cryoballoon Hybrid Ablation With Left Atrial Appendage Exclusion in Persistent and Long Standing Persistent Atrial Fibrillation: A Trac-Af Registry Outcome Study. Circulation, 146(Suppl_1), A14899-A14899.
18. Data based on the post-hoc analysis of long-standing persistent AF sub-groups (N=65) EPi-Sense System Summary of Safety and Effectiveness data: PMA P200002.

PM-US-4859A-0827-G