Short and Intermediate Term Outcomes of the Convergent Procedure: Initial Experience in a Tertiary Referral Center

Ann Thorac Cardiovasc Surg. 2020 Feb 20;26(1):13-21. doi: 10.5761/atcs.oa.19-00164. Epub 2019 Sep 6.

Abstract

Purpose: The Convergent procedure is a hybrid, multidisciplinary treatment for symptomatic atrial fibrillation (AF) consisting of minimally invasive surgical epicardial ablation and percutaneous/catheter endocardial ablation. We investigated outcomes following introduction of the Convergent procedure at our institution.

Methods: Retrospective study examining single-center outcomes. Demographic, procedural, and post-procedural variables were collected with follow-up data obtained at 3, 6, and 12 months.

Results: In all, 36 patients with paroxysmal (11%) or persistent/long-standing persistent (89%) AF underwent the Convergent procedure. 36% also underwent concomitant left atrial appendage (LAA) exclusion by thoracoscopic placement of an epicardial clip. Mean age 60.6 ± 8.0 years with mean arrhythmia burden of 3.9 ± 2.7 years. All patients had failed prior attempts at medical management, 81% had failed prior cardioversion, and 17% had failed prior catheter ablation. Convergent was performed successfully in all patients with no peri-procedural deaths or major complications. At 3 and 12 months, 77.8% and 77.3% of patients, respectively, were free from symptomatic arrhythmia. 65.8% were off anti-arrhythmic medication at 12 months.

Conclusions: The Convergent procedure is safe and has good short- and intermediate-term clinical success rates. This unique hybrid approach combines strengths of surgical and catheter ablation and should be part of any comprehensive AF treatment program.

Keywords: arrhythmia; atrial fibrillation; convergent procedure; hybrid ablation.

MeSH terms

  • Aged
  • Anti-Arrhythmia Agents / therapeutic use
  • Anticoagulants / therapeutic use
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / physiopathology
  • Atrial Fibrillation / surgery*
  • Cardiac Surgical Procedures* / adverse effects
  • Catheter Ablation / adverse effects*
  • Endocardium / physiopathology
  • Endocardium / surgery*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pericardium / physiopathology
  • Pericardium / surgery*
  • Recurrence
  • Referral and Consultation
  • Retrospective Studies
  • Risk Factors
  • Tertiary Care Centers*
  • Time Factors
  • Treatment Outcome

Substances

  • Anti-Arrhythmia Agents
  • Anticoagulants