title: Simultaneous catheter and epicardial ablations enable a comprehensive atrial fibrillation procedure.
abstract: OBJECTIVE
  Transmural and contiguous ablations and a comprehensive lesion pattern are difficult to create from the surface of a beating heart but are critical to the successful treatment of persistent, isolated atrial fibrillation. A codisciplinary simultaneous epicardial (surgical) and endocardial (catheter) procedure (Convergent procedure) addresses these issues.
  
  
  METHODS
  Patients with symptomatic atrial fibrillation who failed medical treatment were evaluated. Using only pericardioscopy, the surgeon performed near-complete epicardial isolation of the pulmonary veins and a "box" lesion on the posterior left atrium using unipolar radiofrequency ablation. Simultaneous endocardial catheter radiofrequency ablation completed pulmonary vein isolation, performed a mitral annular and cavotricuspid isthmus line of block, and debulked the coronary sinus. Twelve-month results for the Convergent procedure were compared with 12-month results for concomitant and pericardioscopic (stand-alone transdiaphragmatic/thoracoscopic) atrial fibrillation procedures using unipolar radiofrequency ablation.
  
  
  RESULTS
  Sixty-five patients underwent the Convergent procedure (mean age, 62 y; mean body surface area, 2.17 m²; mean atrial fibrillation duration, 4.8 y; mean left atrial size, 5.2 cm). Ninety-two percent were in persistent or long-standing persistent atrial fibrillation. At 12 months, evaluation with 24-hour Holter monitors found 82% of patients in sinus rhythm, while only 47% of pericardioscopic and 77% of concomitant patients treated with unipolar radiofrequency ablation were in sinus rhythm.
  
  
  CONCLUSIONS
  Simultaneous epicardial and endocardial ablation improves outcomes for patients with persistent or longstanding persistent atrial fibrillation. This successful collaboration between cardiac surgeon and electrophysiologist is an important treatment option for patients with large left atriums and chronic atrial fibrillation.
authors.affiliation: Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7065, USA. andy_kiser@med.unc.edu
authors.forename: Andy C
authors.initials: AC
authors.lastname: Kiser
authors.forename: Mark D
authors.initials: MD
authors.lastname: Landers
authors.forename: Ker
authors.initials: K
authors.lastname: Boyce
authors.forename: Matjaz
authors.initials: M
authors.lastname: Sinkovec
authors.forename: Andrej
authors.initials: A
authors.lastname: Pernat
authors.forename: Borut
authors.initials: B
authors.lastname: Geršak