Emory Saint Joseph’s Hospital is offering a new minimally invasive procedure to treat patients suffering from longstanding persistent atrial fibrillation (AF) called the Convergent procedure. The Convergent combines the expertise of a cardiac electrophysiologist and a cardiothoracic surgeon, and involves the ablation of the inside and outside of the heart to restore regular rhythm to the heart.
At Emory Saint Joseph’s, David DeLurgio, MD, director of electrophysiology, and cardiothoracic surgeon Michael Halkos, MD, are working collaboratively to provide the best outcome for AF patients. AF patients experience irregular heartbeat, fatigue and shortness of breath, and in addition to these symptoms, are also at increased risk of stroke or heart failure. This persistent condition has been historically difficult to treat, and the Convergent procedure is a new option for patients where traditional medical therapies have failed, such as medication or a standard endocardial ablation.
“Many patients have experienced less than optimal results with medical treatment of their atrial fibrillation and have been told they have to live with the symptoms it produces. The Convergent procedure offers hope for maintenance of a normal rhythm and improved quality of life with a minimally invasive approach,” says DeLurgio.
The Convergent procedure is performed under anesthesia and takes approximately four to six hours. The goal is to restore a patient’s normal heart rhythm through ablation. A two-step process is used to block the abnormal electrical signals that cause an irregular heartbeat. First, the cardiothoracic surgeon makes a small incision in the abdomen to gain access to the outside of the heart through the diaphragm. The surgeon then uses epicardial ablation to produce lesions (scar tissue) on the heart in order to block these signals.
Next, the electrophysiologist enters the inside of the heart through a vein in the leg to ablate the abnormal signals that occur in and around the pulmonary veins.
“This hybrid procedure combines the best of what the electrophysiologist and the surgeon have to offer” says Halkos. “With the surgical portion, the surgeon ablates the back of the left atrium, typically the most challenging portion for the electrophysiologist. The electrophysiologist can use advanced mapping techniques to ensure successful ablation, and reliably ablate the pulmonary veins and other specific lesion sets. Although long-term data does not yet exist, we are optimistic that this will provide relief for a significant proportion of patients with symptomatic atrial fibrillation.” After the procedure, patients typically spend two nights in the hospital and should plan to rest at home for one week, DeLurgio adds.