What does this research mean for the field?

Concomitant convergent ablation, left atrial appendage closure, and minimally invasive direct coronary artery bypass during a single operation is feasible and safe at one-year follow-up. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

October 25, 2025CureusOpen Access

Concomitant Convergent Ablation, Left Atrial Appendage Closure, and Minimally Invasive Direct Coronary Artery Bypass: A Case Series

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Coronary artery disease and atrial fibrillation (n=3). Intervention: Concomitant convergent ablation, left atrial appendage closure, and minimally invasive direct coronary artery bypass (MIDCAB). Primary outcome: Feasibility and safety (intraoperative, postoperative, and 1-year serious adverse events).

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Key result

Concomitant convergent ablation, LAA closure, and MIDCAB proves feasible with zero major 1-year events.

Why the study?

The feasibility and safety of concomitant convergent ablation, left atrial appendage closure, and minimally invasive direct coronary artery bypass during a single operation were unknown.

Is concomitant convergent ablation, left atrial appendage closure, and minimally invasive direct coronary artery bypass safe and feasible in patients with left anterior descending artery disease and atrial fibrillation?

Study Design

Type

Case Report (n=3)

Multicenter

Structured PICO

Population

Three male patients, aged 64 to 76 years, with complex coronary artery disease and atrial fibrillation underwent a novel combined surgical procedure and were followed for 12 months.

Intervention

Concomitant convergent ablation (epicardial radiofrequency ablation), thoracoscopic left atrial appendage (LAA) closure using AtriClip, and minimally invasive direct coronary artery bypass (MIDCAB) grafting of the left internal mammary artery (LIMA) to the LAD during a single-stage operation.

Outcome

Feasibility and safety of concomitant convergent ablation, LAA closure, and MIDCAB during a single-stage operationsafety

Combining convergent ablation, left atrial appendage closure, and minimally invasive direct coronary artery bypass into a single operation appears feasible and safe, offering a new surgical approach for complex patients.

Limitations

Follow-up of only 12 months
Rhythm assessment was performed using a 12-lead ECG combined with a history of symptoms, but not Holter monitoring
Patients received only standard-of-care examinations postoperatively without systematic follow-up angiography, electrophysiological mapping, or CT scans
Sampling bias cannot be excluded
Findings are based on a very small sample of only three cases
Rhythm assessment performed using 12-lead ECG combined with symptom history, not Holter monitoring
Patients received only standard-of-care postoperative examinations without routine imaging or mapping to evaluate surgical success
Long operation times

Implication

May support single-stage approach in AF with CAD; hypothesis-generating and requires prospective trials before adoption.

Abstract

We present the first report of concomitant convergent ablation, left atrial appendage (LAA) closure, and minimally invasive direct coronary artery bypass (MIDCAB) procedures during a single operation. Three patients had coronary artery disease of the left anterior descending artery and atrial fibrillation. All were offered concomitant convergent ablation and LAA closure during the MIDCAB procedure. There were no intra- or postoperative events. At one-year follow-up, no serious adverse events had occurred. One patient had experienced a relapse of paroxysmal atrial fibrillation, and one patient, with a well-functioning graft, had been medically optimized for angina. Our report shows that combining convergent ablation, LAA closure, and MIDCAB can be done feasibly and safely, enabling efficient minimally invasive approaches to future complex cases.

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Published by Cureus · CC BY

Cite This Study

Loft et al. (2025) conducted a case report in Coronary artery disease and atrial fibrillation (n=3). Concomitant convergent ablation, left atrial appendage closure, and minimally invasive direct coronary artery bypass (MIDCAB) was evaluated on Feasibility and safety (intraoperative, postoperative, and 1-year serious adverse events). Concomitant convergent ablation, left atrial appendage closure, and minimally invasive direct coronary artery bypass was feasible and safe, with no intraoperative, postoperative, or serious adverse events at 12 months.

synapsesocial.com/papers/6ac5ac993fb32ca1eb0643ec https://doi.org/10.7759/cureus.95372