The convergent procedure: a multidisciplinary atrial fibrillation treatment.
BACKGROUND
Persistent atrial fibrillation (AF) and long-standing persistent AF (LSPAF) are difficult to treat. Epicardial surgical and percutaneous catheter ablations have lower success rates in these patients. The convergent procedure, an endoscopic transdiaphragmatic ablation procedure with conventional percutaneous endocardial ablation, is examined.


METHODS
Twenty-eight patients with persistent AF or LSPAF underwent the convergent procedure. All underwent combined surgical epicardial radiofrequency ablation and electrophysiological transseptal endocardial ablation to electrically isolate the 4 pulmonary veins, to exclude the posterior left atrium, to ablate the coronary sinus, and to confirm block at the cavotricuspid isthmus. Follow-up was with 24-hour Holter monitoring at 3 months, and 24-hour or 7-day monitoring at 6 and 12 months.


RESULTS
The mean duration of the procedure was 187 minutes (102 surgical ablation minutes; 85 endocardial ablation minutes). The mean total fluoroscopy time was 35.1 minutes. Two patients developed symptomatic pericardial effusions requiring percutaneous drainage, and 1 patient has demonstrated phrenic nerve paresis. There were no deaths. At 3 months, 87% were in sinus rhythm, and 43% were free of AF and antiarrhythmic medications (AADs). At 6 months, 76% were free from AF and AADs.


CONCLUSIONS
The convergent procedure effectively combines surgical and electrophysiological AF expertise to provide a viable treatment option to patients with persistent AF or LSPAF. Long-term follow-up is under way.
Kiser
Andy C
AC
FirstHealth Arrhythmia Center, FirstHealth Moore Regional Hospital, Pinehurst, NC 28374, USA. akiser@firsthealth.org
Landers
Mark
M
Horton
Rodney
R
Hume
Andrew
A
Natale
Andrea
A
Gersak
Borut
B
D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization; D017115:Catheter Ablation / Q000379:methods*; D017548:Echocardiography, Transesophageal; D015716:Electrocardiography, Ambulatory; D004699:Endocardium / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D010496:Pericardium / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome