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Updated: Dec 28, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
The convergent procedure versus catheter ablation alone in longstanding persistent atrial fibrillation: A single
E Maclean1, J Yap2, B Saberwal2
1Barts Heart Centre, St Bartholomew's Hospital, W Smithfield, London EC1A 7BE, UK; William Harvey Research Institute, Charterhouse Square, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK.
Insights
The convergent procedure, combining minimally invasive surgery and catheter ablation, significantly improves arrhythmia-free survival for patients with longstanding persistent atrial fibrillation (PeAF) compared to catheter ablation alone. While complications are noted, the procedure shows long-term efficacy.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Maintaining sinus rhythm is difficult for patients with longstanding persistent atrial fibrillation (PeAF).
- Minimally invasive surgical ablation combined with catheter ablation, known as the convergent procedure, may offer improved outcomes for PeAF.
- This study assesses the safety and effectiveness of the convergent procedure against catheter ablation alone in longstanding PeAF patients.
Purpose of the Study:
- To evaluate the efficacy of the convergent procedure in achieving and maintaining sinus rhythm in patients with longstanding persistent atrial fibrillation.
- To compare the safety and complication rates of the convergent procedure versus catheter ablation alone.
- To determine predictors of long-term arrhythmia-free survival after ablation for longstanding PeAF.
Main Methods:
- A cohort of 43 consecutive patients with longstanding PeAF underwent the convergent procedure (subxiphoid endoscopic posterior left atrial ablation followed by catheter ablation).
- Outcomes were compared to a matched group of 43 patients who had undergone catheter ablation alone.
- Primary outcome was 12-month AF-free survival; secondary outcomes included EHRA class, echocardiography, complications, and long-term arrhythmia-free survival.
Main Results:
- The convergent procedure group showed significantly higher 12-month AF-free survival, both on anti-arrhythmic drugs (AADs) (60.5% vs. 25.6%) and off AADs (37.2% vs. 13.9%).
- Long-term follow-up (30.5 months) also demonstrated superior arrhythmia-free survival for the convergent procedure group, on AADs (58.1% vs. 30.2%) and off AADs (32.5% vs. 11.6%).
- The convergent procedure was identified as a significant predictor of long-term arrhythmia-free survival (OR 3.06).
Conclusions:
- The convergent procedure offers improved arrhythmia-free survival for patients with longstanding persistent atrial fibrillation compared to catheter ablation alone.
- While complication rates were higher in the convergent group, they decreased with experience.
- The study supports the convergent procedure as an effective treatment for longstanding PeAF, with potential for long-term rhythm control.
Background:
Maintenance of sinus rhythm is challenging in patients with longstanding persistent atrial fibrillation (PeAF). Minimally invasive surgical AF ablation may improve outcomes when combined with catheter ablation (the 'convergent' procedure). This study evaluates the safety and efficacy of the convergent procedure versus catheter ablation alone in longstanding PeAF.
Methods:
43 consecutive patients with longstanding PeAF underwent subxiphoid endoscopic ablation of the posterior left atrium followed by catheter ablation from 2013 to 2018. The primary outcome was AF-free survival at 12 months; secondary outcomes included change in EHRA class, echocardiographic data, procedural complications, freedom from anti-arrhythmic drugs (AADs), and long term arrhythmia-free survival. Outcomes were compared with a matched group of 43 patients who underwent catheter ablation alone. Both groups underwent multiple catheter ablations as required. Baseline characteristics were similar between groups.
Results:
After 12 months, the convergent procedure was associated with increased AF-free survival on AADs (60.5% versus 25.6%, p = .002) and off AADs (37.2% versus 13.9%, p = .025), versus catheter ablation. Allowing for multiple procedures, after 30.5 ± 13.3 months' follow-up the convergent procedure was associated with increased arrhythmia-free survival on AADs (58.1% versus 30.2%, p = .016) and off AADs (32.5% versus 11.6%, p = .036) versus catheter ablation. There were more complications in the convergent procedure group (11.6% versus 2.3%, p = .2). Multivariate analysis identified only the convergent procedure (OR 3.06 (1.23-7.6), p = .017) as predictive of arrhythmia-free survival long term.
Conclusions:
In longstanding PeAF, the convergent procedure is associated with improved arrhythmia-free survival versus catheter ablation alone. Complication rates are significant but have been shown to depreciate with experience.
