Purpose: The Convergent procedure is a hybrid, multidisciplinary treatment for symptomatic atrial fibrillation (AF) consisting of minimally invasive surgical epicardial ablation and percutaneous/catheter endocardial ablation. We investigated outcomes following introduction of the Convergent procedure at our institution. Methods: Retrospective study examining single-center outcomes. Demographic, procedural, and post-procedural variables were collected with follow-up data obtained at 3, 6, and 12 months. Results: In all, 36 patients with paroxysmal (11%) or persistent/long-standing persistent (89%) AF underwent the Convergent procedure. 36% also underwent concomitant left atrial appendage (LAA) exclusion by thoracoscopic placement of an epicardial clip. Mean age 60.6 ± 8.0 years with mean arrhythmia burden of 3.9 ± 2.7 years. All patients had failed prior attempts at medical management, 81% had failed prior cardioversion, and 17% had failed prior catheter ablation. Convergent was performed successfully in all patients with no peri-procedural deaths or major complications. At 3 and 12 months, 77.8% and 77.3% of patients, respectively, were free from symptomatic arrhythmia. 65.8% were off anti-arrhythmic medication at 12 months. Conclusions: The Convergent procedure is safe and has good short-and intermediate-term clinical success rates. This unique hybrid approach combines strengths of surgical and catheter ablation and should be part of any comprehensive AF treatment program.

Among patients requiring device system revision for Twiddler's syndrome, the use of nonabsorbable antimicrobial pouches was associated with significantly fewer recurrences of lead dislodgement events.

The PACED-OP protocol implementation was associated with a significant reduction in the odds of device reprogramming without a significant difference in the odds of CRMD-related complications.

The purpose of this study was to determine the percentage of time that patients are subtherapeutic, therapeutic, and supratherapeutic based on the recommended INR for therapeutic efficacy when prescribed warfarin for chemical thromboprophylaxis following a hip or knee arthroplasty procedure. One hundred eighty-four patients receiving warfarin for 4 weeks postoperatively, dosed using a web-application accounting for patient demographics, INR levels, and concomitant medication use, were included for analysis. On average, patients with a target INR range between 1.7-2.7 were therapeutic for only 54.4% of the time (32.5% subtherapeutic, 13.0 supratherapeutic) while patients with a target INR range between 2.0 and 3.0 were therapeutic for only 45.9% of the time (39.2% subtherapeutic, 14.8% supratherapeutic) of their warfarin regimen. This study confirms that patients receiving warfarin for chemical thromboprophylaxis are within their targeted INR range for only a limited period of time during their postoperative course.

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