Abstract 13863: Outcomes of Hybrid Convergent Procedure in Patients With Persistent and Longstanding, Persistent Atrial Fibrillation

Abstract

Introduction: The primary indications for AF ablation are to reduce symptoms, time in AF and burden of medical management. Catheter ablation has suboptimal outcomes in persistent/longstanding persistent AF, however the hybrid Convergent procedure (combined endocardial and epicardial ablation) has shown promising results. The study objective was to evaluate outcomes of Convergent hybrid procedure for AF. Methods: The Convergent procedure involves a cardiac surgeon ablating the pulmonary veins (PV) and left atrial posterior wall epicardially via subxyphoid or transdiaphragmatic access. The EP then endocardially isolates the pulmonary veins and other AF triggers evident during mapping. A retrospective analysis of outcomes at a mean follow up of one year after Convergent ablation was performed. The composite burden score, which is a summation of a) AF burden, b) frequency of symptoms, and c) AAD status was calculated at baseline and at various follow-up intervals (see Table 1). Results: Fifty-seven consecutive highly symptomatic AF patients received Convergent ablation between October 2014-March 2019 at a single center. Baseline parameters were mean age 65.9 ± 9.2 years, 39% female, 52% LVEF, 4.3±4.3 years in continuous AF. Primary safety events were similar to those reported with endocardial catheter ablation. Of 57 patients, 29 (51%) had continuous rhythm monitors and the rest received ECG every 3-6 months until last follow-up. At a mean follow up of 350±122 days, 77% patients either had no AF or were free from AF at least 95% of the time. The composite burden score significantly reduced during 1 year since Convergent ablation (p<0.001, Figure 1). Conclusion: Convergent hybrid procedure is safe and reduces the burden of AF as shown by sustained improvement in AF symptoms, reduction in AAD usage and reduction in time in AF. A heart team approach where the cardiac surgeon and EP collaborate is effective in the treatment of persistent/long-standing persistent AF.