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Convergent ablation for persistent atrial fibrillation: Single center experience
Author(s) -
Gulkarov Iosif,
Wong Brian,
Kowalski Marcin,
Worku Berhane,
Afzal Ashwad,
Ivanov Alexander,
Ramasubbu Kumudha,
Reddy Bharath
Publication year - 2019
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.14204
Subject(s) - medicine , atrial fibrillation , sinus rhythm , atrial flutter , catheter ablation , perioperative , retrospective cohort study , ablation , single center , cardiology , cohort , surgery , complication
Abstract Background Endocardial catheter ablation has been shown to be effective in patients with paroxysmal atrial fibrillation (AF), and significantly less effective in patients with persistent AF (PAF). Lately, there is a trend toward a hybrid approach in the treatment of PAF that may be a more durable treatment for patients with PAF. In this manuscript we report our experience with the convergent ablation procedure in a PAF cohort. Methods This is a single center retrospective analysis of 31 patients with PAF who underwent the convergent procedure. All patients underwent surgical epicardial ablation of the posterior left atrial through a subxiphoid approach, followed by radiofrequency endocardial ablations on the same day. Patients were followed at 6 months intervals with static electrocardiograms or implanted devices. Results Sinus rhythm was achieved intraoperatively in all patients. Recurrence was defined according to Hearlt Rhythm Society definitions. At a median follow up of 17.7 months (IQR 11‐24), the recurrence of atrial tachyarrhythmia (AF and atrial flutter) by Kaplan‐Meier event free survival analysis occurred in 9 (29%) patients at 1‐year follow up and 15 (48%) patients at 2‐year follow up with or without the use of antiarrhythmic drugs. Recurrence of AF alone occurred in 4 (13%) patients at 1‐year follow up and 9 (29%) patients at 2‐year follow up patients. Complication rate in perioperative period was 12.9%. Conclusion Our experience showed the hybrid procedure is a relatively safe and effective option for patients with PAF. Further studies are needed to better determine its long‐term outcomes