{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T11:32:43Z","timestamp":1784892763676,"version":"3.55.0"},"reference-count":32,"publisher":"Elsevier BV","issue":"2","license":[{"start":{"date-parts":[[2021,2,1]],"date-time":"2021-02-01T00:00:00Z","timestamp":1612137600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2021,2,1]],"date-time":"2021-02-01T00:00:00Z","timestamp":1612137600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"funder":[{"DOI":"10.13039\/100008497","name":"Boston Scientific Corporation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008497","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001316","name":"Abbott Laboratories","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001316","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004374","name":"Medtronic","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004374","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007330","name":"AtriCure","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007330","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","heartrhythmjournal.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Heart Rhythm"],"published-print":{"date-parts":[[2021,2]]},"DOI":"10.1016\/j.hrthm.2020.10.004","type":"journal-article","created":{"date-parts":[[2020,10,9]],"date-time":"2020-10-09T03:45:53Z","timestamp":1602215153000},"page":"303-312","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":32,"title":["Combined epicardial and endocardial ablation for atrial fibrillation: Best practices and guide to hybrid convergent procedures"],"prefix":"10.1016","volume":"18","author":[{"given":"Kevin J.","family":"Makati","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitesh","family":"Sood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence S.","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian C.","family":"Shults","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David B.","family":"DeLurgio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juraj","family":"Melichercik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaswinder S.","family":"Gill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riyaz A.","family":"Kaba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed","family":"Ahsan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rukshen","family":"Weerasooriya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pragnesh","family":"Joshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Lellouche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuri","family":"Blaauw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Zannis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederic A.","family":"Sebag","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre","family":"Gauri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael O.","family":"Zembala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Tondo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan S.","family":"Steinberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.hrthm.2020.10.004_bib1","doi-asserted-by":"crossref","first-page":"e275","DOI":"10.1016\/j.hrthm.2017.05.012","article-title":"2017 HRS\/EHRA\/ECAS\/APHRS\/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation","volume":"14","author":"Calkins","year":"2017","journal-title":"Heart Rhythm"},{"key":"10.1016\/j.hrthm.2020.10.004_bib2","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1001\/jama.2009.2029","article-title":"Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial","volume":"303","author":"Wilber","year":"2010","journal-title":"JAMA"},{"key":"10.1016\/j.hrthm.2020.10.004_bib3","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1001\/jama.2019.0693","article-title":"Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA randomized clinical trial","volume":"321","author":"Packer","year":"2019","journal-title":"JAMA"},{"key":"10.1016\/j.hrthm.2020.10.004_bib4","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1016\/j.amjcard.2011.11.058","article-title":"Six year follow-up after catheter ablation of atrial fibrillation: a palliation more than a true cure","volume":"109","author":"Sorgente","year":"2012","journal-title":"Am J Cardiol"},{"key":"10.1016\/j.hrthm.2020.10.004_bib5","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1161\/CIRCEP.111.968032","article-title":"Clinical outcome of catheter ablation in patients with nonparoxysmal atrial fibrillation: results of 3-year follow-up","volume":"5","author":"Chao","year":"2012","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"10.1016\/j.hrthm.2020.10.004_bib6","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1161\/CIRCEP.111.963819","article-title":"The Cox-Maze procedure for lone atrial fibrillation: a single-center experience over 2 decades","volume":"5","author":"Weimar","year":"2012","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"10.1016\/j.hrthm.2020.10.004_bib7","doi-asserted-by":"crossref","first-page":"88","DOI":"10.15420\/aer.2019.20","article-title":"The convergent AF ablation procedure: evolution of a multidisciplinary approach to AF management","volume":"9","author":"Wats","year":"2020","journal-title":"Arrhythm Electrophysiol Rev"},{"key":"10.1016\/j.hrthm.2020.10.004_bib8","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1161\/CIRCEP.111.962720","article-title":"Left atrial anatomy revisited","volume":"5","author":"Ho","year":"2012","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"10.1016\/j.hrthm.2020.10.004_bib9","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1111\/jce.12651","article-title":"Age, atrial fibrillation, and structural heart\u00a0disease are the main determinants of left atrial fibrosis detected by delayed-enhanced magnetic resonance imaging in a general cardiology population","volume":"26","author":"Cochet","year":"2015","journal-title":"J Cardiovasc Electrophysiol"},{"key":"10.1016\/j.hrthm.2020.10.004_bib10","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1016\/j.hrthm.2019.03.012","article-title":"The rationale for isolation of the left atrial pulmonary venous component to control atrial fibrillation: a review article","volume":"16","author":"Elbatran","year":"2019","journal-title":"Heart Rhythm"},{"key":"10.1016\/j.hrthm.2020.10.004_bib11","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCEP.118.007005","article-title":"Feasibility, safety, and efficacy of posterior wall isolation during atrial fibrillation ablation: a systematic review and meta-analysis","volume":"12","author":"Thiyagarajah","year":"2019","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"10.1016\/j.hrthm.2020.10.004_bib12","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1016\/j.jacep.2017.12.009","article-title":"Preserved left atrial epicardial conduction in regions of endocardial \u201cisolation.\u201d","volume":"4","author":"Glover","year":"2018","journal-title":"JACC Clin Electrophysiol"},{"key":"10.1016\/j.hrthm.2020.10.004_bib13","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.hrthm.2015.08.019","article-title":"Proven isolation of the pulmonary vein antrum with or without left atrial posterior wall isolation in patients with persistent atrial fibrillation","volume":"13","author":"Bai","year":"2016","journal-title":"Heart Rhythm"},{"key":"10.1016\/j.hrthm.2020.10.004_bib14","doi-asserted-by":"crossref","unstructured":"DeLurgio DB, Crossen K, Gill J, et\u00a0al. Convergence of epicardial and endocardial RF ablation for the treatment of symptomatic persistent AF. Paper presented at: Heart Rhythm Scientific Sessions; May 8, 2020.","DOI":"10.1016\/j.ahj.2020.02.016"},{"key":"10.1016\/j.hrthm.2020.10.004_bib15","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1056\/NEJMoa1707855","article-title":"Catheter ablation for atrial fibrillation with heart failure","volume":"378","author":"Marrouche","year":"2018","journal-title":"N Engl J Med"},{"key":"10.1016\/j.hrthm.2020.10.004_bib16","doi-asserted-by":"crossref","first-page":"13","DOI":"10.5761\/atcs.oa.19-00164","article-title":"Short and intermediate term outcomes of the Convergent procedure: initial experience in a tertiary referral center","volume":"26","author":"Tonks","year":"2019","journal-title":"Ann Thorac Cardiovasc Surg"},{"key":"10.1016\/j.hrthm.2020.10.004_bib17","first-page":"S366","article-title":"Emerging evidence of improvement in left ventricular ejection fraction after convergent ablation in persistent and longstanding persistent AF patients with reduced ejection fraction","volume":"17","author":"Oza","year":"2020","journal-title":"Heart Rhythm"},{"key":"10.1016\/j.hrthm.2020.10.004_bib18","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1053\/j.optechstcvs.2019.04.002","article-title":"Subxiphoid minimally invasive epicardial ablation (Convergent procedure) with left thoracoscopic closure of the left atrial appendage","volume":"23","author":"Lee","year":"2018","journal-title":"Oper Tech Thorac Cardiovasc Surg"},{"key":"10.1016\/j.hrthm.2020.10.004_bib19","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1046\/j.1540-8167.2003.02487.x","article-title":"Pericardial anatomy for the interventional electrophysiologist","volume":"14","author":"D\u2019Avila","year":"2003","journal-title":"J Cardiovasc Electrophysiol"},{"key":"10.1016\/j.hrthm.2020.10.004_bib20","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.pbiomolbio.2014.07.007","article-title":"Role of endo-epicardial dissociation of electrical activity and transmural conduction in the development of persistent atrial fibrillation","volume":"115","author":"Verheule","year":"2014","journal-title":"Prog Biophys Mol Biol"},{"key":"10.1016\/j.hrthm.2020.10.004_bib21","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.jacep.2016.10.010","article-title":"Comparative effectiveness of hybrid ablation versus endocardial catheter ablation alone in patients with persistent atrial fibrillation","volume":"3","author":"Kress","year":"2017","journal-title":"JACC Clin Electrophysiol"},{"key":"10.1016\/j.hrthm.2020.10.004_bib22","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1016\/S0735-1097(20)31051-2","article-title":"Safety and efficacy of a convergent hybrid procedue using cryo as endocardial energy source for the treatment of persistent and longstanding persistent atrial fibrillation","volume":"75","author":"Makati","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.hrthm.2020.10.004_bib23","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1016\/j.athoracsur.2016.04.018","article-title":"Long-term success for the convergent atrial fibrillation procedure: 4-year outcomes","volume":"102","author":"Gersak","year":"2016","journal-title":"Ann Thorac Surg"},{"key":"10.1016\/j.hrthm.2020.10.004_bib24","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1111\/j.1540-8167.2012.02355.x","article-title":"Low rate of atrial fibrillation recurrence verified by implantable loop recorder monitoring following a convergent epicardial and endocardial ablation of atrial fibrillation","volume":"23","author":"Gersak","year":"2012","journal-title":"J Cardiovasc Electrophysiol"},{"key":"10.1016\/j.hrthm.2020.10.004_bib25","doi-asserted-by":"crossref","first-page":"65","DOI":"10.15420\/aer.2013.2.1.65","article-title":"Closed chest convergent epicardial-endocardial ablation of non-paroxysmal atrial fibrillation\u2014a case series and literature review","volume":"2","author":"Thosani","year":"2013","journal-title":"Arrhythm Electrophysiol Rev"},{"key":"10.1016\/j.hrthm.2020.10.004_bib26","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.ijcard.2019.10.053","article-title":"The convergent procedure versus catheter ablation alone in longstanding persistent atrial fibrillation: a single centre, propensity-matched cohort study","volume":"303","author":"Maclean","year":"2020","journal-title":"Int J Cardiol"},{"key":"10.1016\/j.hrthm.2020.10.004_bib27","first-page":"S367","article-title":"Prospective multicenter arrhythmia free survival using hybrid convergent ablation in non paroxysmal atrial fibrillation patients","volume":"16","author":"Makati","year":"2019","journal-title":"Heart Rhythm"},{"key":"10.1016\/j.hrthm.2020.10.004_bib28","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1161\/CIRCULATIONAHA.109.928903","article-title":"Left atrial appendage: an underrecognized trigger site of atrial fibrillation","volume":"122","author":"Di Biase","year":"2010","journal-title":"Circulation"},{"key":"10.1016\/j.hrthm.2020.10.004_bib29","unstructured":"Steinberg JS, Romanov A. Left atrial appendage isolation for ablation of atrial fibrillation: has a yellow flag been raised? JACC Clin Electrophysiol. In press."},{"key":"10.1016\/j.hrthm.2020.10.004_bib30","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1093\/icvts\/ivs136","article-title":"Epicardial left atrial appendage clip occlusion also provides the electrical isolation of the left atrial appendage","volume":"15","author":"Starck","year":"2012","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"10.1016\/j.hrthm.2020.10.004_bib31","series-title":"Comparison of hybrid ablation for persistent atrial fibrillation with and without left atrial appendage closure: report of 1 year follow up","author":"Gegochkori","year":"2019"},{"key":"10.1016\/j.hrthm.2020.10.004_bib32","doi-asserted-by":"crossref","first-page":"481","DOI":"10.3111\/13696998.2014.911185","article-title":"Cost-effectiveness of the convergent procedure and catheter ablation for non-paroxysmal atrial fibrillation","volume":"17","author":"Anderson","year":"2014","journal-title":"J Med Econ"}],"container-title":["Heart Rhythm"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1547527120309450?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1547527120309450?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T06:52:47Z","timestamp":1761547967000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1547527120309450"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2]]},"references-count":32,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,2]]}},"alternative-id":["S1547527120309450"],"URL":"https:\/\/doi.org\/10.1016\/j.hrthm.2020.10.004","relation":{},"ISSN":["1547-5271"],"issn-type":[{"value":"1547-5271","type":"print"}],"subject":[],"published":{"date-parts":[[2021,2]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Combined epicardial and endocardial ablation for atrial fibrillation: Best practices and guide to hybrid convergent procedures","name":"articletitle","label":"Article Title"},{"value":"Heart Rhythm","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.hrthm.2020.10.004","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2020 Heart Rhythm Society. All rights reserved.","name":"copyright","label":"Copyright"}]}}