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Updated: Jan 5, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
The convergent procedure: a hybrid approach for long lasting persistent atrial fibrillation ablation
Konstantinos Zannis1, Wissam Alam2, Frederic A Sebag3
1Unit of Cardiac Surgery, Institut Mutualiste Montsouris (IMM), Paris, France - konstantinoszannis@gmail.com.
Insights
A new hybrid ablation for persistent atrial fibrillation (AF) is safe and effective. This convergent procedure successfully restored sinus rhythm in 76% of patients after one year, offering hope for difficult-to-treat AF.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Atrial fibrillation (AF) increases stroke, heart failure, and mortality risks.
- The Cox-Maze procedure is effective but invasive; endocardial ablation has limited success in persistent AF.
- A novel minimally invasive hybrid approach, the convergent procedure, combines endocardial and epicardial ablation for persistent AF.
Purpose of the Study:
- To evaluate the safety and efficacy of the convergent procedure for treating long-lasting persistent AF.
- To assess outcomes in patients with prior failed endocardial ablation.
Main Methods:
- A study of 55 consecutive patients with long-lasting persistent AF undergoing the convergent procedure.
- Patients had prior failed endocardial ablation and were highly symptomatic; thoracic surgery history excluded.
- Follow-up included 24-hour Holter ECGs at 3, 6, and 12 months, with all patients reaching 1-year follow-up.
Main Results:
- No immediate deaths, strokes, phrenic nerve palsy, or tamponade.
- Average post-surgery stay was 8 days; 5% developed diaphragmatic hernia, leading to technique modification.
- At 12 months, 76% achieved sinus rhythm after an average of 1.43 ablation procedures; 91% remained on antiarrhythmic drugs.
Conclusions:
- The thoracoscopic hybrid epicardial-endocardial ablation (convergent procedure) is safe and effective.
- This technique offers a viable solution for patients with long-lasting persistent AF and previous failed ablation.
- The procedure demonstrates good long-term efficacy in restoring sinus rhythm.
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.
