Borut Geršak1, Matevž Jan2. 1. University of Ljubljana School of Medicine, Ljubljana, Slovenia; Department of Cardiovascular Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia. Electronic address: bgersak@maat.si. 2. Department of Cardiovascular Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia.
Abstract
BACKGROUND: The objective of this single-center study was to report long-term efficacy outcomes of the convergent procedure for the treatment of atrial fibrillation. METHODS: Outcomes for the convergent procedure were determined by clinical presentation and interrogating implanted loop recorders. Rhythm status and required interventions for atrial fibrillation recurrence (antiarrhythmic drugs, cardioversions, and repeat ablations) were quantified 1 to 4 years after the procedure. Long-term outcomes, atrial fibrillation burden quantified with continuous monitoring, and patient baseline characteristics were analyzed and reported. RESULTS: Seventy-six consecutive patients with paroxysmal (5%), persistent (16%), or longstanding atrial fibrillation (79%) underwent the convergent procedure between January 2009 and July 2013. Clinical presentation in sinus rhythm at isolated timepoints was 88% at 6 months, 85% at 1 year, 85% at 2 years, 84% at 3 years, and 81% at 4 years of follow-up. Total patients requiring repeat catheter ablation was 18% through 4 years. Single procedure 1-year success (freedom from atrial fibrillation/atrial flutter/atrial tachycardia through 1 year and off antiarrhythmic drugs) was 56%; and long-term success (freedom from atrial fibrillation/atrial flutter/atrial tachycardia through at least 36 months and off antiarrhythmic drugs) was 45%. CONCLUSIONS: Four-year outcomes for the convergent procedure are promising and demonstrate the ability to maintain sinus rhythm in a predominantly persistent and longstanding atrial fibrillation population. Increasing the extent of posterior ablation should be evaluated for patients with enlarged atria to account for the potential increase in fibrosis distribution and other atrial remodeling markers that produce arrhythmogenic substrates.
BACKGROUND: The objective of this single-center study was to report long-term efficacy outcomes of the convergent procedure for the treatment of atrial fibrillation. METHODS: Outcomes for the convergent procedure were determined by clinical presentation and interrogating implanted loop recorders. Rhythm status and required interventions for atrial fibrillation recurrence (antiarrhythmic drugs, cardioversions, and repeat ablations) were quantified 1 to 4 years after the procedure. Long-term outcomes, atrial fibrillation burden quantified with continuous monitoring, and patient baseline characteristics were analyzed and reported. RESULTS: Seventy-six consecutive patients with paroxysmal (5%), persistent (16%), or longstanding atrial fibrillation (79%) underwent the convergent procedure between January 2009 and July 2013. Clinical presentation in sinus rhythm at isolated timepoints was 88% at 6 months, 85% at 1 year, 85% at 2 years, 84% at 3 years, and 81% at 4 years of follow-up. Total patients requiring repeat catheter ablation was 18% through 4 years. Single procedure 1-year success (freedom from atrial fibrillation/atrial flutter/atrial tachycardia through 1 year and off antiarrhythmic drugs) was 56%; and long-term success (freedom from atrial fibrillation/atrial flutter/atrial tachycardia through at least 36 months and off antiarrhythmic drugs) was 45%. CONCLUSIONS: Four-year outcomes for the convergent procedure are promising and demonstrate the ability to maintain sinus rhythm in a predominantly persistent and longstanding atrial fibrillation population. Increasing the extent of posterior ablation should be evaluated for patients with enlarged atria to account for the potential increase in fibrosis distribution and other atrial remodeling markers that produce arrhythmogenic substrates.