Convergent Ablation for the Treatment of Long Standing Persistent Atrial Fibrillation - A Single Center Experience

Introduction: The treatment of long standing persistent atrial fibrillation (AF) is very challenging and conventional catheter ablation strategies have provided only modest success. They often require multiple procedures and anti-arrhythmics to maintain sinus rhythm. The convergent ablation procedure is a hybrid approach, involving a minimally invasive epicardial ablation combined with a traditional transvenous endocardial ablation. Hypothesis: Convergent ablation is an overall safe and effective procedure for the treatment of long standing persistent AF. Methods: From February 2015 to September 2017, 30 patient (20 males) with long standing persistent AF underwent convergent ablation at a large tertiary care center. Rest of the baseline characteristics are in Table 1. The epicardial ablation was performed via a sub-xyphoid, endoscopic approach followed by transvenous endocardial ablation (five radiofrequency and twenty-two cryoablation). Results: Mean procedural time was 4.5 ± 0.7 hours. Mean hospital stay was 4.9 ± 1.2 days. Acute procedural success was 100%, defined as complete pulmonary vein isolation. Out of thirty, twenty-two patients were discharged on anti-arrhythmic drugs (AAD). At thirty days eighteen (60%) patients and at one year nineteen (63.3%) patients were in normal sinus rhythm and off AAD. There were no major procedural complications. Remaining results are outlined in Table 1. Conclusions: Convergent ablation is an effective alternative treatment for long standing persistent atrial fibrillation demonstrating high success rates with low complication rates. However, longer follow up and prospective trials are needed