The convergent procedure: a hybrid approach for long lasting persistent atrial fibrillation ablation.

Abstract

Atrial fibrillation (AF) is associated with increased risk of stroke, heart failure and all-cause mortality. The Cox-Maze procedure is the most effective approach to ablate persistent AF but presents a significant morbidity and mortality. Additionally, the classical endocardial ablation approach has limited efficacy to treat long lasting persistent AF. We described a new, minimally invasive hybrid approach, combining an endocardial and epicardial ablation named convergent procedure to treat long lasting persistent AF patients. We studied 55 consecutive patients with long lasting persistent AF who underwent the convergent procedure in 2 French centers between 2010 and 2015. All patients had at least one previous failed endocardial ablation and were highly symptomatic. Patients with a history of thoracic surgery were excluded. A 24 hour-Holter ECG was performed systematically at 3, 6 and 12 months after the convergent procedure. All patients reached 1-year follow-up. No death, stroke, phrenic nerve palsy or tamponade occurred immediately after the procedure. Post-surgery average length of stay was 8±4 days. Later, 3 patients (5%) developed diaphragmatic hernia resulting in a modified surgery technique. At 12 months, 76% of patients were in sinus rhythm after an average of 1.43 ablation procedure. Finally, 91% of patients were maintained on antiarrhythmic drugs. Thoracoscopic hybrid epicardial-endocardial ablation technique proved to be effective and safe to treat long lasting persistent AF patients with previous failed endocardial AF ablation.