26Good medium term success of convergent hybrid AF ablation in persistent AF
Bibliographic record
Abstract
Introduction: Catheter ablation of persistent and long-standing persistent AF ablation has significantly worse success rates than for paroxysmal AF with only about 50% of patients remaining in SR at 12 months. This has led to the development of a number of alternative treatment strategies. The Convergent AF ablation is a minimally invasive surgical epicardial ablation (providing a box lesion to isolate the posterior LA) with an endocardial approach to isolate the pulmonary veins. 80% maintenance of SR has been reported in small European/US studies and here we report our medium term results as the 1stparticipating UK centre. Patient Selection: 17 patients with symptomatic persistent and long-standing persistent AF have undergone a Convergent AF ablation since July 2012. They were selected due to adverse success features for endocardial ablation (AF duration, LA size, multiple failed catheter ablations etc). Mean age was 64 years (43-82), average AF duration 6.7 years, 8 patients had previously failed persistent AF ablations, mean LA diameter 45mm (4 patients >50 mm, 2 patients >60mm), LVEF 51% (25-60%). Results: SR at discharge was achieved in all patients. Early recurrences (<6 months) were relatively common (42%, AF n=2, Aflutter n=4, with 5 patients requiring elective DCCV and 1 spontaneously cardioverted). Subsequent practice change led to antiarrhythmics being continued for 6 months post procedure. Despite these early recurrences longer term SR maintenance was good (electrocardiogram evidence of SR at 3, 6, 9, 12 and 18 months were 8/14 (57%), 10/14 (71%). 7/8 (88%), 7/8 (86%) and 2/2 (see figure for rhythm breakdown). Holter monitoring confirmed SR in 7/8 (88%) at 12 months (6/8 in SR off antiarrhythmics). Mean follow up was 11.4 months. In total 7 patients underwent DCCV during follow-up and there have been no repeat ablations. Procedural complications were 1 wound infection and 1 coronary sinus bleed (sutured laparoscopically during the procedure). Conclusions: The Convergent Hybrid AF ablation appears to be a good treatment option for persistent AF. Despite relatively common early recurrences the medium term success rates were better than predicted by standard therapy, even in our patient group with multiple adverse features.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".