Abstract 11802: Transforming the Convergent Procedure- Thinking Inside the Box

Abstract

Introduction: We report on intermediate follow up using a technique of confluent posterior left atrial wall epicardial ablation designed to eliminate both existing and future atrial fibrillation (AF) substrate. Hypothesis: The purpose of this study is to report on our experience with a technique of extended ablation using a confluent pattern of posterior left atrial epicardial lesions combined with endocardial ablation, as part of the Convergent hybrid closed chest procedure, performed in a single setting. Methods: Multiple confluent epicardial ablations with radiofrequency energy were delivered spanning the vertical and transverse dimensions of the posterior left atrium, along with facilitated pulmonary vein isolation (PVI). Endocardial mapping and ablation were performed to complete PVI and ablate the cavo-tricuspid isthmus. All patients were followed clinically and with 2 to 4 weekly continuous monitoring at 6, 12, and 24 months. Average follow-up was 488 days. Results: Of 57 patients with long-standing or persistent AF (NPAF), mean duration of AF was 5.6 years. Single procedure freedom from AF at 24 months was 64.5% and for all arrhythmias was 58.9%. Sixty-eight percent were off antiarrhythmic drugs (AADs). Four patients (7%) required a second endocardial ablation procedure. Sub-analysis of the observed arrhythmia burden through follow-up showed it to be small (0 to less than 1%) in the majority of patients. Conclusions: This extended posterior wall ablation technique, as part of the Convergent hybrid method, achieved notable single procedure success in a consecutive series of patients with NPAF.