ORIGINAL ARTICLE  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2020 June;61(3):369-75

DOI: 10.23736/S0021-9509.19.10701-X

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

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

Konstantinos ZANNIS ¹ ✉, Wissam ALAM ², Frederic A. SEBAG ¹, Thierry FOLLIGUET ³, Clement BARS ⁴, Miche FAHED ², Julien TERNACLE ², Eric BERGOEND ², David HAMON ², Nicolas LELLOUCHE ²

¹ Unit of Cardiac Surgery, Institut Mutualiste Montsouris (IMM), Paris, France; ² Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris et INSERM U 955, Creteil, France; ³ Centre Hospitalier Régional Universitaire de Nancy (CHRU), University of Lorraine, Vandoeuvre les Nancy, France; ⁴ Interventional Rhythmology, Saint Joseph Hospital, Marseille, France

BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.

KEY WORDS: Atrial fibrillation; Ablation techniques; Combined modality therapy