title: Low rate of atrial fibrillation recurrence verified by implantable loop recorder monitoring following a convergent epicardial and endocardial ablation of atrial fibrillation.
abstract: OBJECTIVE
  Evaluate long-term outcomes in patients undergoing the Convergent procedure (CP) for the treatment of atrial fibrillation (AF).
  
  
  BACKGROUND
  The CP provides a multidisciplinary approach, combining endoscopic creation of epicardial linear lesions followed by endocardial mapping and ablation and targets persistent and longstanding persistent AF patients who are at increased risk of heart failure, stroke, and mortality.
  
  
  METHODS
  Outcomes from a prospective nonrandomized study were recorded for consecutive patients by interrogation of implanted Reveal monitors. Rhythm status and AF burden were quantified 6-24 months postprocedure, and compared relative to AF type, gender, age, body mass index, left atrial size, left ventricular ejection fraction, and congestive heart failure, hypertension, age >75 years, age between 65 and 74 years, stroke/TIA/TE, vascular disease (previous MI, peripheral arterial disease or aortic plaque), diabetes mellitus, female (CHA(2) DS(2) VASc).
  
  
  RESULTS
  A total of 50 patients were enrolled with 94% having persistent or longstanding persistent AF. There were 2 atrioesophageal fistulas reported. In one patient, the fistula resulted in death at 33 days postprocedure; in the second, the fistula was surgically repaired but patient died 8 months postprocedure from a CVI. After CP, 95% of patients were in sinus rhythm at 6-month follow-up; 88% at 12 months; and 87% at 24 months. The median AF burden recorded with Reveal XT monitors was 0.0%, 0.1%, and 0.1% at 6, 12, and 24 months with 81%, 81%, and 87% of patients reporting a burden less than 3%, respectively.
  
  
  CONCLUSIONS
  Using 24 × 7 continuous loop recording, the CP demonstrated success in treating persistent and longstanding persistent AF patients. Endocardial mapping and catheter ablation with diagnostic confirmation of procedural success complemented the endoscopic creation of epicardial linear lesions in restoring sinus rhythm.
authors.affiliation: Department of Cardiovascular Surgery, University Medical Center Ljubljana, Zaloska, Ljubljana, Slovenia. bgersak@maat.si
authors.forename: Borut
authors.initials: B
authors.lastname: Gersak
authors.forename: Andrej
authors.initials: A
authors.lastname: Pernat
authors.forename: Boris
authors.initials: B
authors.lastname: Robic
authors.forename: Matjaz
authors.initials: M
authors.lastname: Sinkovec
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D022062:Electrophysiologic Techniques, Cardiac / Q000295:instrumentation; D004699:Endocardium / Q000503:physiopathology / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D006339:Heart Rate; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000295:instrumentation; D010496:Pericardium / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013686:Telemetry / Q000295:instrumentation; D013997:Time Factors; D016896:Treatment Outcome