Long-Term Outcome after Convergent Procedure for Atrial Fibrillation

Background The aim of this single-center retrospective study is to evaluate the long-term outcome after convergent procedure (CP) for patients with paroxysmal atrial fibrillation (AF), persistent AF and long-standing persistent AF. Methods and results We analyzed outcomes of patients that underwent CP from January 2009 until July 2020. 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 outcome was assessed at 1-year after CP and at long-term follow up. At 1-year follow up rhythm and daily AF burden were assessed for patients with implantable loop recorder (61.2%). For others rhythm was assessed by clinical presentation and 12-lead ECG recording. At long-term follow up patients having sinus rhythm or unclear history of AF were monitored with 7-day ECG Holter and AF burden was determined. Long-term success was defined as freedom from AF/atrial flutter (AFL) with sinus rhythm on 12-lead ECG recording and AF/AFL burden <1% on 7-day Holter ECG. Repeat catheter ablations (RFA) prior to long-term follow up were documented. At 1-year follow up 91.4% of patients had sinus rhythm 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 sinus rhythm and 53.8% patients had AF/AFL burden <1% on 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 increased risk of AF recurrence. Conclusions CP resulted in high long-term probability of sinus rhythm maintenance. During long-term follow-up additional RFAs were required to maintain sinus rhythm in a substantial number of patients.