Methods
Study Design :
This retrospective, single-center, observational study was conducted
with the goal of improvement of patient care and safety at Orlando
Health Heart and Vascular Institute. The study was approved by the
Orlando Health Institutional Review Board. Data of patients who
underwent either conventional cryoballoon pulmonary vein isolation (CB
PVI) or hybrid convergent ablation at Orlando Regional Medical Center
from January 2010 through
December 2015 were recorded at the time of the procedure. Proceduralists
included three electrophysiologists and one cardiothoracic surgeon.
Patients in the registry consented to the procedure.
Patient Population :
Patients considered for study were adults with all forms of AF,
including patients with prior failed CB PVI. At least one outpatient
evaluation 90 days post-procedure (blanking period) was required during
follow-up. The following criteria were utilized to determine who was
treated by convergent procedure: 1) PAF with failed class I/III
antiarrhythmic drug (AAD) therapy and previously failed CB PVI ablation
or 2) persistent and LSPAF with failed class I/III AAD willing to
undergo the hybrid procedure. The following criteria were utilized to
determine who was treated by CB PVI: 1) PAF with failed class I/III AAD
or 2) persistent and LSPAF with failed class I/III AAD; unwilling to
undergo hybrid procedure. Exclusion criteria included valvular disease
that, in the opinion of the surgeon, needed surgical correction.
Additionally, prior sternotomy was excluded. Previously documented
pericarditis was not an absolute contraindication and all of these cases
were successfully ablated.