{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T21:07:02Z","timestamp":1773090422296,"version":"3.50.1"},"reference-count":14,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,6,19]],"date-time":"2024-06-19T00:00:00Z","timestamp":1718755200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>A hybrid convergent approach (endocardial and epicardial ablation) demonstrated superior effectiveness in a recent randomized study for long\u2010standing persistent atrial fibrillation (LSPAF). Yet, there is a lack of real\u2010world, long\u2010term evidence as to which patients are best candidates for a hybrid convergent approach compared to standard endocardial cryoballoon pulmonary vein isolation (CB PVI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and Results<\/jats:title><jats:p>This single\u2010center, retrospective analysis spanning from 2010 to 2015 compared two distinctly different atrial fibrillation (AF) cohorts; one treated with stand\u2010alone cryoablation and one treated with a hybrid convergent approach. Baseline characteristics described candidates for each approach. The following criteria were utilized to determine CB PVI candidacy: (1) paroxysmal AF (PAF) (stage 3A) with failed class I\/III antiarrhythmic drug (AAD) or (2) persistent\/LSPAF (stage 3B\/3C\/3D) with failed class I\/III AAD unwilling to undergo hybrid procedure. Selection criteria for the hybrid procedure included: (1) PAF refractory to both class I\/III AAD and prior CB PVI (stage 3D) or (2) persistent\/LSPAF (stage 3B\/3C\/3D) with failed class I\/III AAD agreeable to hybrid procedure. Prior sternotomy was excluded. Serial electrocardiograms and continuous monitoring evaluated primary efficacy outcome of time\u2010to\u2010first recurrence of atrial arrhythmia after a 90\u2010day blanking period. Secondary outcomes were procedure\u2010related complications and AAD use (at discharge, 12, and 36 months). Kaplan\u2010Meier methods evaluated arrhythmia recurrence. Of 276 patients, 197 (64.2\u2009\u00b1\u200910.6 years old; 66.5% male; 74.1% 3A\u2010PAF; 18.3% 3B\/3D\u2010persistent AF; 1.0% 3C\u2010LSPAF; 6.6% undetermined) underwent CB PVI and 79 (61.4\u2009\u00b1\u20098.1 years old; 83.5% male; 41.8% 3D\u2010PAF; 45.5% 3B\/3D\u2010persistent AF; 12.7% 3C\/3D\u2010LSPAF) underwent hybrid procedure. Arrhythmia freedom through 36 months was 55.2% for CB PVI and 50.4% for hybrid (<jats:italic>p<\/jats:italic>\u2009=\u2009.32). Class I AAD utilization at discharge occurred in 38 (19.3%) patients in the CB PVI group and 5 (6.3%) patients in the hybrid group (<jats:italic>p<\/jats:italic>\u2009=\u2009.01). CB PVI class I AAD utilization at 12 months occurred in 14 (9.0) patients versus 0 patients for hybrid convergent (<jats:italic>p<\/jats:italic>\u2009=\u2009.004). Patients with one or more adverse event were as follows: two (1.0%) in the CB PVI group (both transient phrenic nerve palsy) and three (3.7%) in the hybrid group (two with significant bleeding and one with wound infection) (<jats:italic>p<\/jats:italic>\u2009=\u2009.14).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study demonstrated that patients with more complex forms of AF (3D\u2010PAF or 3B\/3C\/3D\u2010persistent\/LSPAF) could be well managed with a convergent approach. In a real\u2010world evaluation, outcomes match safety and efficacy thresholds achieved for patients with earlier, less complex AF etiologies treated by CB PVI alone.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.16327","type":"journal-article","created":{"date-parts":[[2024,6,20]],"date-time":"2024-06-20T05:35:25Z","timestamp":1718861725000},"page":"1624-1632","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Real\u2010world evidence demonstrates an appropriate atrial fibrillation population for hybrid convergent approach versus stand\u2010alone cryoballoon ablation: A long\u2010term safety and efficacy study"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8891-9713","authenticated-orcid":false,"given":"Christian","family":"Lorenzo","sequence":"first","affiliation":[{"name":"Department of Cardiology and Electrophysiology Orlando Health Heart and Vascular Institute Orlando Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yahaira","family":"Ortiz\u2010Gonzalez","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Electrophysiology Orlando Health Heart and Vascular Institute Orlando Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dustin","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Electrophysiology Orlando Health Heart and Vascular Institute Orlando Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Kinaga","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Electrophysiology Orlando Health Heart and Vascular Institute Orlando Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren","family":"Filart","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Electrophysiology Orlando Health Heart and Vascular Institute Orlando Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Bello","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Electrophysiology Orlando Health Heart and Vascular Institute Orlando Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aurelio","family":"Duran","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Electrophysiology Orlando Health Heart and Vascular Institute Orlando Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffery","family":"Bott","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Electrophysiology Orlando Health Heart and Vascular Institute Orlando Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shivangi","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Electrophysiology Orlando Health Heart and Vascular Institute Orlando Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary Janette","family":"Sendin","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Electrophysiology Orlando Health Heart and Vascular Institute Orlando Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roland","family":"Filart","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Electrophysiology Orlando Health Heart and Vascular Institute Orlando Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,6,19]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2017.05.012"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.15420\/aer.2019.20"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.120.009288"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hroo.2022.05.006"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2020.10.004"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2018.04.021"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi507"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eum120"},{"key":"e_1_2_10_10_1","doi-asserted-by":"crossref","unstructured":"JoglarJA ChungMK ArmbrusterAL et al.2023 ACC\/AHA\/ACCP\/HRS Guideline for the Diagnosis 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Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jce.16327","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T05:37:21Z","timestamp":1734413841000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jce.16327"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,19]]},"references-count":14,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2024,8]]}},"alternative-id":["10.1111\/jce.16327"],"URL":"https:\/\/doi.org\/10.1111\/jce.16327","archive":["Portico"],"relation":{},"ISSN":["1045-3873","1540-8167"],"issn-type":[{"value":"1045-3873","type":"print"},{"value":"1540-8167","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,19]]},"assertion":[{"value":"2023-06-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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