Clinical Outcomes of Hybrid Convergent Ablation Versus Pulsed Field Catheter Ablation for Persistent Atrial Fibrillation

Abstract 2315908, presented at Western Atrial Fibrillation Symposium 2026

The hybrid Convergent surgery has demonstrated improved arrhythmic outcomes for patients with persistent atrial fibrillation (PsAF) compared to endocardial ablation alone. Recent studies have established pulsed-field ablation (PFA) as a rapid, safe, and effective modality for durable pulmonary vein isolation. However, the efficacy of extensive PFA with pulmonary vein isolation and posterior wall isolation (PVI and PWI) for patients with PsAF or longstanding persistent atrial fibrillation (LSPsAF) compared to Convergent ablation is not well described.We performed a retrospective cohort study of patients with PsAF or LSPsAF undergoing either hybrid Convergent ablation between 2021–2024 or endocardial PFA catheter ablation using the Farapulse system (Boston Scientific, Marlborough, MA) between July and December 2024. The Convergent procedure was performed in a staged fashion with surgical epicardial ablation followed by endocardial ablation. Endocardial lesion sets in both cohorts consisted of PVI and PWI. The primary efficacy endpoint was arrhythmia recurrence at 1 year, defined as any documented atrial tachyarrhythmia lasting ≥30 seconds after the blanking period.A total of 136 patients were included (n = 71 Convergent and n = 65 PFA endocardial ablation only). At 1 year, Kaplan-Meier analysis showed significantly higher recurrence-free survival in the Convergent cohort compared with the PFA cohort (78.8% vs 63.6%, log-rank p = 0.04). Procedural safety outcomes were favorable in both groups (major complication rate of 3.1% Convergent vs 3.1% PFA).Convergent surgery demonstrated improved 1-year freedom from arrhythmia recurrence compared with endocardial PFA alone. These findings suggest that comprehensive epicardial–endocardial substrate modification confers incremental benefit over endocardial PFA in PsAF.