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Long-Term Success for the Convergent Atrial Fibrillation Procedure: 4-Year Outcomes
1University of Ljubljana School of Medicine, Ljubljana, Slovenia; Department of Cardiovascular Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia.
Insights
The convergent procedure shows promising four-year efficacy for treating atrial fibrillation, maintaining sinus rhythm in most patients, including those with persistent or longstanding conditions.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Atrial fibrillation (AF) management remains a clinical challenge.
- The convergent procedure offers a minimally invasive approach for AF treatment.
- Long-term outcomes data for the convergent procedure are essential for clinical decision-making.
Purpose of the Study:
- To evaluate the long-term efficacy of the convergent procedure in treating atrial fibrillation.
- To assess rhythm status and intervention rates for AF recurrence up to four years post-procedure.
- To analyze atrial fibrillation burden and patient characteristics after the convergent procedure.
Main Methods:
- Single-center study reporting on 76 patients undergoing the convergent procedure.
- Outcomes assessed via clinical presentation and implanted loop recorders.
- Quantification of rhythm status, AF recurrence, and interventions (medications, cardioversions, repeat ablations) from 1 to 4 years.
Main Results:
- 81% of patients maintained sinus rhythm at 4 years post-procedure.
- 18% of patients required repeat catheter ablation within 4 years.
- One-year success rate was 56%, with a 45% long-term success rate (≥36 months off antiarrhythmic drugs).
Conclusions:
- The convergent procedure demonstrates promising 4-year outcomes for atrial fibrillation.
- The procedure effectively maintains sinus rhythm, particularly in persistent and longstanding AF populations.
- Future research should explore optimizing ablation extent for patients with enlarged atria.
Background:
The objective of this single-center study was to report long-term efficacy outcomes of the convergent procedure for the treatment of atrial fibrillation.
Methods:
Outcomes for the convergent procedure were determined by clinical presentation and interrogating implanted loop recorders. Rhythm status and required interventions for atrial fibrillation recurrence (antiarrhythmic drugs, cardioversions, and repeat ablations) were quantified 1 to 4 years after the procedure. Long-term outcomes, atrial fibrillation burden quantified with continuous monitoring, and patient baseline characteristics were analyzed and reported.
Results:
Seventy-six consecutive patients with paroxysmal (5%), persistent (16%), or longstanding atrial fibrillation (79%) underwent the convergent procedure between January 2009 and July 2013. Clinical presentation in sinus rhythm at isolated timepoints was 88% at 6 months, 85% at 1 year, 85% at 2 years, 84% at 3 years, and 81% at 4 years of follow-up. Total patients requiring repeat catheter ablation was 18% through 4 years. Single procedure 1-year success (freedom from atrial fibrillation/atrial flutter/atrial tachycardia through 1 year and off antiarrhythmic drugs) was 56%; and long-term success (freedom from atrial fibrillation/atrial flutter/atrial tachycardia through at least 36 months and off antiarrhythmic drugs) was 45%.
Conclusions:
Four-year outcomes for the convergent procedure are promising and demonstrate the ability to maintain sinus rhythm in a predominantly persistent and longstanding atrial fibrillation population. Increasing the extent of posterior ablation should be evaluated for patients with enlarged atria to account for the potential increase in fibrosis distribution and other atrial remodeling markers that produce arrhythmogenic substrates.
