Abstract 13074: Convergent Ablation for Long-Standing Persistent Atrial Fibrillation: Single Center Experience From a Large Regional Medical Center

Abstract

Introduction: The treatment of long-standing, persistent AF is challenging. Conventional transvenous radiofrequency (RF) ablation strategies have provided only modest success, often requiring multiple procedures to maintain normal sinus rhythm. The convergent ablation procedure is a hybrid approach, involving a minimally invasive epicardial ablation combined with a traditional transvenous endocardial ablation. This comprehensive approach may offer a more effective treatment for long-standing persistent AF. Methods: From 12/2013 through 05/2015, we performed 50 convergent ablations (40 male; 10 female) for symptomatic, long-standing persistent AF. Mean age was 64.1±9.2 years with a mean CHADS-VASC score of 2.5±1.5. Mean LA volume was 161.5±44.5 cc. Mean weight was 103.3 kg ± 23.1 kg, and mean LVEF was 51.7%±21.7%. All patients had failed at least one anti-arrhythmic medication. Epicardial ablation was performed via a sub-xyphoid, endoscopic approach followed by transvenous endocardial ablation (32 RF and 18 cryoablation). Transvenous cavo-tricuspid isthmus (CTI) ablation was performed in all patients using RF energy. Results: Mean procedural time was 2.4±0.6 hours (epicardial) and 2.9±0.75 hours (endocardial). Acute procedural success was 100%, defined as complete pulmonary vein isolation, comprehensive ablation of the posterior LA, and CTI block. Mean hospital stay was 3.4±1.7 days. At mean follow-up of 206±150 days, 47 remain in NSR (94%). Of those patients who underwent transvenous radiofrequency (RF) ablation, 29 of 32 were in sinus rhythm (91%), while 18 of 18 of those who underwent cryo-ablation were in sinus rhythm (100%). At last follow-up, anti-arrhythmic therapy was discontinued in 22 patients (44%). Major complications occurred in 2 patients (4%): rectus hematoma and pericardial tamponade. Conclusions: Convergent ablation is an effective treatment for long-standing persistent AF, demonstrating high success rates with low complication rates. Longer follow-up and prospective, randomized trials are needed.