European experience of the convergent atrial fibrillation procedure: Multicenter outcomes in consecutive patients

Geršak, Borut; Zembala, Michael O.; Müller, D.; Folliguet, Thierry; Jan, Matevž; Kowalski, Oskar; Erler, Stefan; Bars, Clément; Robic, Boris; Filipiak‬, Krzysztof J.; Wimmer‐Greinecker, Gerhard

doi:10.1016/j.jtcvs.2013.06.057

Cited by 66 publications

(42 citation statements)

References 18 publications

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“…Freedom from arrhythmia at 6 and 12 months post-procedure was 78.3% and 84.1%, respectively. Geršak et al reported similar success with convergent procedure for treatment in 76 patients with paroxysmal and non-paroxysmal AF and at 4 years follow up, 81% of patients were in sinus rhythm (86,87). Potential benefits of convergent procedure include less radiation exposure, shorter electrophysiology catheterbased procedure, reduction in the likelihood of esophageal injury that may be caused by endocardial ablation.…”

Section: Hybrid Approachmentioning

confidence: 90%

Ablation of long-standing persistent atrial fibrillation

Mody¹,

Raza²,

Jacobson³

et al. 2017

Ann. Transl. Med.

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Atrial fibrillation (AF) is the most commonly encountered arrhythmia in the clinical setting affecting nearly 6 million people in United States and the numbers are only expected to rise as the population continues to age. Broadly it is classified into paroxysmal, persistent and longstanding persistent AF.Electrical, structural and autonomic remodeling are some of the diverse pathophysiological mechanisms that contribute to the persistence of AF. Our review article emphasizes particularly on long standing persistent atrial fibrillation (LSPAF) aspect of the disease which poses a great challenge for electrophysiologists. While pulmonary vein isolation (PVI) has been established as a successful ablation strategy for paroxysmal AF, same cannot be said for LSPAF owing to its long duration, complexity of mechanisms, multiple triggers and substrate sites that are responsible for its perpetuation. The article explains different approaches currently being adopted to achieve freedom from atrial arrhythmias. These mainly include ablation techniques chiefly targeting complex fractionated atrial electrograms (CFAE), rotors, linear lesions, scars and even considering hybrid approaches in a few cases while exploring the role of delayed enhancement magnetic resonance imaging (deMRI) in the pre-procedural planning to improve the overall short and long term outcomes of catheter ablation.

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Section: Hybrid Approachmentioning

confidence: 90%

Ablation of long-standing persistent atrial fibrillation

Mody¹,

Raza²,

Jacobson³

et al. 2017

Ann. Transl. Med.

View full text Add to dashboard Cite

show abstract

“…More recently, the convergent procedure 92 , which combines endoscopic surgical access to the epicardial space via the diaphragm for ablation of the posterior left atrium with catheterbased endocardial ablation, has shown promise ( figure 3E). The thoracoscopic approach avoids direct trauma to the chest compared to traditional surgical approaches, while direct visualization can reduce complications while allowing large atrial areas to be targeted while confirming success via traditional electrophysiologic endpoints.…”

Section: Evolving Technical Aspects Of Ablation: Less Is Morementioning

confidence: 99%

Ablation of Atrial Fibrillation

2017

Fogoros' Electrophysiologic Testing

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Ablation is increasingly used to treat AF, since recent trials of pharmacological therapy for AF have been disappointing. Ablation has been shown to improve maintenance of sinus rhythm compared to pharmacological therapy in many multi center trials, although success rates remain suboptimal. This review will discuss several trends in the field of catheter ablation, including studies to advance our understanding of AF mechanisms in different patient populations, innovations in detecting and classifying AF, use of this information to improve strategies for ablation, technical innovations that have improved the ease and safety of ablation, and novel approaches to surgical therapy and imaging. These trends are likely to further improve results from AF ablation in coming years as it becomes an increasingly important therapeutic option for many patients.

show abstract

“…More recently, the convergent procedure 92 , which combines endoscopic surgical access to the epicardial space via the diaphragm for ablation of the posterior left atrium with catheter-based endocardial ablation, has shown promise (figure 3E). The thoracoscopic approach avoids direct trauma to the chest compared to traditional surgical approaches, while direct visualization can reduce complications while allowing large atrial areas to be targeted while confirming success via traditional electrophysiologic endpoints.…”

Section: Evolving Technical Aspects Of Ablation: Less Is Morementioning

confidence: 99%

“…The thoracoscopic approach avoids direct trauma to the chest compared to traditional surgical approaches, while direct visualization can reduce complications while allowing large atrial areas to be targeted while confirming success via traditional electrophysiologic endpoints. Recent single-procedure success of 52% (and multiprocedure on-drug results of 80%) 92 are promising, and longer term assessments of success, safety and atrial function are anticipated.…”

Section: Evolving Technical Aspects Of Ablation: Less Is Morementioning

confidence: 99%