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Long-Term Outcomes after Convergent Procedure for Atrial Fibrillation
Borut Geršak1, Veronika Podlogar2, Tine Prolič Kalinšek2
1Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia.
Insights
The convergent procedure (CP) for atrial fibrillation (AF) shows a high long-term success rate for maintaining sinus rhythm (SR). However, many patients require repeat procedures to sustain SR over time.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Atrial fibrillation (AF) is a common arrhythmia impacting cardiovascular health.
- The convergent procedure (CP) is an interventional treatment for AF.
- Long-term outcomes of CP require further evaluation.
Purpose of the Study:
- To assess the long-term efficacy of the convergent procedure (CP) in treating atrial fibrillation (AF).
- To evaluate the maintenance of sinus rhythm (SR) and AF burden after CP.
- To identify factors associated with AF recurrence post-CP.
Main Methods:
- Retrospective analysis of 119 patients undergoing CP for AF (paroxysmal, persistent, long-standing persistent).
- Outcomes assessed at 1-year and long-term follow-up (mean 8.3 years).
- Rhythm and AF burden evaluated using ECG, Holter monitoring, and implantable loop recorders.
Main Results:
- At 1 year, 91.4% achieved SR and 76.1% had <1% AF burden.
- Long-term follow-up showed 65.5% SR and 53.8% with <1% AF burden.
- Age, BMI, and left atrial volume index predicted AF recurrence.
Conclusions:
- CP offers a high long-term probability of maintaining sinus rhythm for AF patients.
- A significant proportion of patients require additional radiofrequency ablation (RFA) procedures to maintain SR.
- CP is a viable option for AF treatment, but long-term management may involve repeat interventions.
Abstract:
Background: The aim of this single-center retrospective study was to evaluate the long-term outcomes after the convergent procedure (CP) for treatment of AF. Methods: We analyzed the outcomes of patients that underwent CP from January 2009 until July 2020. A total of 119 patients with paroxysmal AF (23.5%), persistent AF (5.9%), or long-standing persistent AF (70.6%) that attended long-term follow-up were included. The outcomes were assessed 1 year after the CP and at long-term follow-up. At the 1-year follow-up, rhythm and AF burden were assessed for patients with an implantable loop recorder (61.2%). For others, rhythm was assessed by clinical presentation and 12-lead ECG. At long-term follow-up, patients with sinus rhythm (SR) or an unclear history were assessed with a 7-day Holter ECG monitor, and AF burden was determined. Long-term success was defined as freedom from AF/atrial flutter (AFL) with SR on a 12-lead ECG and AF/AFL burden < 1% on the 7-day Holter ECG. Results: At 1-year follow-up, 91.4% of patients had SR and 76.1% of patients had AF/AFL burden < 1%. At long-term follow-up (8.3 ± 2.8 years), 65.5% of patients had SR and 53.8% of patients had AF/AFL burden < 1% on the 7-day Holter ECG. Additional RFAs were performed in 32.8% of patients who had AF or AFL burden < 1%. At long-term follow-up, age, body mass index, and left atrial volume index were associated with an increased risk of AF recurrence. Conclusions: CP resulted in high long-term probability of SR maintenance. During long-term follow-up, additional RFAs were required to maintain SR in a substantial number of patients.
