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Updated: Jun 4, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Convergent procedure for long-standing persistent atrial fibrillation in heart failure with reduced ejection fraction
Frédéric A Sebag1, Konstantinos Zannis2, Manel Miled1
1Département de cardiologie, institut mutualiste Montsouris, 75014 Paris, France.
Insights
The convergent procedure effectively treats atrial fibrillation in heart failure patients, improving heart function. This safe ablation method offers significant benefits for long-standing persistent atrial fibrillation.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Catheter ablation for atrial fibrillation (AF) in heart failure with reduced ejection fraction (HFrEF) significantly reduces morbimortality.
- The convergent procedure is a viable option for treating long-standing persistent AF.
Purpose of the Study:
- To evaluate the outcomes of the convergent procedure in patients with HFrEF and long-standing persistent AF.
- To assess the safety and efficacy of this ablation technique in a specific patient cohort.
Main Methods:
- A consecutive series of patients undergoing the convergent procedure between 2009 and 2020 were studied.
- Primary endpoint: freedom from atrial arrhythmia at 3, 6, and 12 months post-procedure via Holter ECG.
- Left ventricular ejection fraction (LVEF) assessed by echocardiography before and 1 year after the procedure.
Main Results:
- 79% of patients (34/43) were free from atrial arrhythmia at 12 months.
- A median absolute improvement in LVEF of 8% was observed at 12 months (P=0.003).
- The procedure demonstrated a favorable safety profile with no periprocedural deaths.
Conclusions:
- The convergent procedure is effective and safe for HFrEF patients with long-standing persistent AF.
- The treatment leads to significant improvements in left ventricular function.
- This ablation strategy offers a promising therapeutic option for this challenging patient group.
Background:
Catheter ablation for atrial fibrillation in patients with heart failure with reduced ejection fraction is associated with a significant reduction in morbimortality. The convergent procedure is a valid ablation option for the treatment of long-standing persistent atrial fibrillation.
Aim:
To describe the outcomes of patients with heart failure with reduced ejection fraction and long-standing persistent atrial fibrillation who underwent the convergent procedure.
Methods:
We studied consecutive patients included in two French centres between 2009 and 2020. Primary endpoint was freedom from any atrial arrhythmia assessed on 24-hour Holter electrocardiogram at 3, 6 and 12 months after the procedure. Left ventricular ejection fraction was assessed on transthoracic echocardiography before and 1 year after the procedure. All patients had at least 12 months of follow-up.
Results:
Forty-three patients were included (86% were men). Baseline left ventricular ejection fraction was 38±10.5% and indexed left atrial volume was 50±27mL/m2. Among the study population, 34 patients (79%) were free from atrial fibrillation/tachycardia at the end of follow-up. No periprocedural death occurred. We observed two groin haematomas and four mild pericardial effusions. At 12-month follow-up, 21 patients (49%) were still on antiarrhythmic drug therapy, and a reduction in antiarrhythmic drug dosage was achieved in 10 patients (23%). The absolute median improvement in left ventricular ejection fraction was 8% at 12 months (P=0.003).
Conclusions:
The convergent procedure has been shown to be effective and safe for patients with patients with heart failure with reduced ejection fraction and long-standing persistent atrial fibrillation, with significant left ventricular function improvement.
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