The Convergent Procedure is a Collaborative Atrial Fibrillation Treatment

A 43-year-old man with a 10-year history of persistent atrial fibrillation (AF) who had failed medical treatment with cardioversion while on class III antiarrhythmic medication presented with persistent and symptomatic AF. Transthoracic echocardiogram demonstrated left atrial size of 7.0 cm and left ventricular ejection fraction of 40%. The patient underwent combined and simultaneous endocardial and epicardial AF ablation (Convergent procedure). He was discharged 3 days later and returned to full activity in 2 weeks. At 12 months, he remained in sinus rhythm by 24-hour Holter monitor without antiarrhythmic medication or anticoagulation, his left atrial size was 4.5 cm and his left ventricular ejection fraction was 55%. He remains in sinus rhythm at 22 months. The Convergent procedure, a collaboration between a surgeon and an electrophysiologist, is an innovative way to provide effective treatment of patients with chronic atrial fibrillation. This convergence of technologies and expertise allows: 1) the creation of a complete, bi-atrial, endocardial, and epicardial ablation pattern without a chest incision or cardiopulmonary bypass; 2) provides intraoperative metrics to confirm procedural success; 3) encourages integrated patient care by cardiac surgery and electrophysiology; and 4) potentially decreases length of hospital stay and the number of repeat ablation procedures.