Subxiphoid left atrial ablation for atrial fibrillation.

Verberkmoes, Niels; Olsthoorn, Jules; Dekker, Lukas; Pieraets, Michiel; Ouss, Alexandre

Atrial fibrillation is becoming a disease that needs to be addressed with definitive long-term treatment as opposed to medical management options. Ablation or isolation of focal triggers around the pulmonary veins can eliminate arrhythmia substrates for patients with paroxysmal, lone atrial fibrillation. However, limited pulmonary vein isolation strategies do not address reentrant circuits common in persistent and longstanding persistent patients with structural heart disease and enlarged atria. The convergent procedure is a hybrid ablation treatment for atrial fibrillation. It consists of surgical ablation of the posterior left atrium through a minimally invasive closed-chest approach followed by endocardial catheter ablation. The convergent procedure was developed to treat atrial fibrillation by creating a complete and comprehensive pattern of linear lesions on the left atrial backwall under direct endoscopic visualization while avoiding chest incisions and deflation of the lungs. Endocardial ablation follows the epicardial procedure to confirm lesion integrity and supplement the epicardial procedure, which is performed in a staged fashion.