Short- and Intermediate-Term Outcomes of the Convergent Procedure in Nonresponders to Conventional Catheter Ablation

Objectives: The convergent procedure (CP) is a hybrid multidisciplinary treatment for symptomatic atrial fibrillation (AF) consisting of a minimally invasive endoscopical epicardial ablation and a percutaneous endocardial control/touch-up catheter ablation (PEA) after a blanking period of 3 months. We investigated outcomes of the convergent procedure in patients that had at least two catheter-based ablations and still symptomatic AF.

Methods: Retrospective/prospective study examining the results of nonresponding patients to PEA. Demographic, procedural, and postprocedural variables were collected with follow-up data at 3, 6, and 12 months.

Result: In 45 patients, the criteria for the CP were met. 89% had long-standing persistent AF and 11% had paroxysmal symptomatic AF. The average numbers of preoperative PEA in all patients were 2.9 ablations (range: 2–9). No concomitant procedure was applied. Mean age was 72 ± 12 with a mean arrhythmia burden of 6.2 years. All patients had failed prior attempts to medical management and all patients had at least 3.3 electrical cardioversions. Convergent was successfully performed in 93% of the patients; in three patients, the procedure due to an adhesive pericarditis was not possible. No major complication was noticed. At 3 and 12 months, 85 and 84% of patients, respectively, were free from symptomatic arrhythmia. A touch-up ablation via PEA was necessary in 10 patients. 70% of the patients were off anti-arrhythmic medication after 12 months.

Conclusion: The convergent procedure is safe and has excellent short- and midterm clinical success rates in an otherwise not treated patient collective. The convergent approach combines the strengths of surgical and catheter ablation and should be part of any comprehensive AF treatment program.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021