title: Closed Chest Convergent Epicardial-Endocardial Ablation of Non-paroxysmal Atrial Fibrillation - A Case Series and Literature Review.
abstract: The closed chest convergent procedure is a multidisciplinary approach to atrial fibrillation (AF) treatment. Epicardial posterior left atrial (PLA) ablation is performed by a cardiac surgeon using a transdiaphragmatic endoscope, immediately followed by percutaneous pulmonary vein (PV) isolation performed by a cardiac electrophysiologist. Interim outcomes for the treatment of non-paroxysmal AF (NPAF) were evaluated based on peri-procedural safety and complications, freedom from recurrent AF, and need for cardioversion or repeat catheter ablation at three, six and 12 months post-procedure. A total of 43 patients (86 % NPAF) underwent the convergent procedure. Patients were 84 % male, with mean age 58.6 ± 8.7 years. Mean AF duration was 45.4 ± 40.3 months. Pre-procedure left atrium (LA) volumetric data using cardiac magnetic resonance imaging (MRI) or computed tomography (CT) was available for 30 patients (70 %). Average LA volume was 155.5 ± 48.4 millilitres (ml); two-thirds of patients had a LA volume >130 ml. There was no operative or peri-operative mortality. Sinus rhythm (SR) was recorded at three months in 31 of 39 (79 %) patients, at six months in 24 of 27 (89 %) patients and at 12 months in nine patients. The convergent procedure is a safe and effective option for both PV isolation and PLA substrate ablation in NPAF patients. Long-term follow-up is required and randomised clinical trials warranted.
authors.affiliation: Division of Cardiac Electrophysiology.
authors.forename: Amit J
authors.initials: AJ
authors.lastname: Thosani
authors.affiliation: Division of Cardiac Electrophysiology.
authors.forename: Paul
authors.initials: P
authors.lastname: Gerczuk
authors.affiliation: Division of Cardiac Electrophysiology.
authors.forename: Emerson
authors.initials: E
authors.lastname: Liu
authors.affiliation: Division of Cardiac Electrophysiology.
authors.forename: William
authors.initials: W
authors.lastname: Belden
authors.affiliation: Division of Cardiothoracic Surgery, Allegheny General Hospital, Pennsylvania, US.
authors.forename: Robert
authors.initials: R
authors.lastname: Moraca
keywords: Atrial fibrillation; ablation; convergent procedure; epicardial–endocardial ablation
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