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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.


Circulation. 2019;140:A14961

Electrophysiology and Arrhythmias Session Title: Atrial Fibrillation Ablation I

Abstract 14961


Cardiology | Surgery


Department of Medicine, Cardiology Division, Department of Medicine Faculty, Department of Medicine Fellows and Residents

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