The convergent procedure is an innovative means of treating persons with chronic atrial fibrillation (or AFib) that combines two previously developed procedures, a minimally invasive surgical technique and a second ablation technique performed using a catheter. As a hybrid, these two procedures ablate, or remove, the tissues producing off-pattern electrical charges that are causing a heart arrhythmia. The convergent procedure is showing evidence of improved outcomes for chronic AFib patients, superior to either of the procedures performed singly.

Atrial fibrillation is an arrhythmia in which an abnormal pattern of electrical charges in the heart’s upper chambers causes the heart to accelerate and beat irregularly. An estimated 2.3 million individuals have this condition, making it the most common form of arrhythmia or heart murmur in the U.S. Though not always life-threatening, the persistent form of AFib is associated with an increased risk of strokes and heart disease. The convergent ablation procedure targets those AFib patients with a higher risk profile, slowing and normalizing the heartbeat, reducing related symptoms, and decreasing the risk of more serious illness or injury.

The convergent procedure is a promising new avenue for improving the care of persons with chronic atrial fibrillation. If you or a loved one is living with AFib and want to learn more, contact the cardiac-care specialists at Baptist Healthcare.

How the Convergent Procedure Works

The convergent procedure was developed to improve care for persons with medically serious cases of AFib. These are individuals whose condition has resisted standard treatments, including medications and single invasive procedures. The convergent procedure combines two types of ablation and is performed, in turn, by a cardiothoracic surgeon and an electrophysiologist.

1. Epicardial Ablation

In a convergent procedure, the epicardial ablation is performed first. This part of the procedure focuses on the exterior of the heart and is conducted by means of minimally invasive surgery. You’ll receive a general anesthetic beforehand and will be unconscious during the operation. The cardiothoracic surgeon makes a small cut in your abdomen and guides a surgical tool to your heart, where he or she deploys either radiofrequency ablation (extreme heat) or cryoablation (extreme cold) to destroy misfiring cells in the heart’s muscular structure. These cells are typically located on the back wall of the atrium, or upper left chamber of the heart. The surgical tool is withdrawn through the incision at the procedure’s finish.

The goal of this surgery is to destroy those cells that are producing faulty electrical charges. These charges inhibit the proper coordination of the heart’s four chambers in pumping blood, resulting in uncertain blood flow and an off-pattern heartbeat. Eliminating these cells assists the heart in returning to a healthy, natural rhythm, while restoring proper blood flow, and reducing the likelihood strokes and heart disease.

2. Endocardial Ablation

The endocardial ablation is the second part of the combined procedure. This aspect is conducted inside the heart by means of a catheter or long tube with surgical instruments and sensors. An electrophysiologist, or EP, inserts the catheter into a blood vessel through an incision near the groin. He or she directs the catheter to the heart where the sensor is used to map the electrical charges on the heart’s interior. This enables the EP to determine which cells are the source of the dysfunctional electrical signals. He or she will then use radiofrequency or extreme-cold ablation to eliminate those cells. All of this can be monitored in real-time through the use of a fluoroscope, an X-ray videography machine, during the procedure.

Endocardial ablation is a second means of restoring a healthy heartbeat by destroying those cells disrupting blood flow through mistimed electrical signals. The convergent procedure’s success in treating patients with chronic atrium fibrillation is due in part to the comprehensive nature of the way in which it eliminates problem-causing cells.

3. Closing Incisions

At the end of the procedure, the medical team will clean and close the surgical and catheter incisions. A drainage tube may be left in place while you remain on site. Your post-operative condition will be monitored by the hospital staff until you go home, which will likely be in one or two days following the procedure.

Who Is a Candidate for This Procedure?

The convergent procedure for atrial fibrillation was developed to treat individuals with persistent and longstanding versions of this condition. These persons:

• Exhibit common AFib symptoms, such as an irregular heartbeat, labored breathing, fatigue, dizziness, and chest pain
• Have typically undergone other forms of treatment that proved ineffective
• Are possibly intolerant of standard AFib medications
• Have sometimes experienced heart failure or other forms of heart disease

Persons with a previous history of heart surgery, or who are unable to take blood-thinning medications, are not recommended for the convergent procedure.

To learn whether you or a loved one is a good candidate for the convergent procedure, arrange for a medical evaluation with your healthcare provider. The evaluation process will likely include a medical history review, lab work, and imaging appointments.

Preparing for the Procedure

If you are scheduled for a convergent procedure, please take the following steps to beforehand:

• Do not eat or drink anything after midnight on the day the procedure is going to take place.
• Stop the use of any tobacco products, including cigarette smoking.
• Get guidance from your physician on which medications you can take while you’re in the hospital. Some of your usual medications, such as blood thinners, may be suspended temporarily. Others can be taken on the day of the procedure with small sips of water.
• Dress comfortably for the hospital. You’ll be provided with a gown prior to the procedure.
• Do not wear jewelry. Leave it and any other valuables at home.

You may undergo a CT scan and/or an echocardiogram beforehand. This is to confirm your readiness to undergo the procedure.

After the Procedure

You will begin your post-operative recovery in the Intensive Care Unit (ICU) before returning to your room. You may experience some mild chest pain. Let your nurses know if you have other symptoms, such as shortness of breath.

On your release from the hospital, arrange to have a family member or friend drive you home. Don’t undertake any strenuous activities, such as exercise or heavy lifting, for a couple of weeks following a convergent procedure. You should be able to return to your normal routine by week three.

Complications

There is, to date, little evidence of convergent procedure complications. Fewer than one percent of the patients experienced post-operative difficulties of a serious nature in the first clinical trial.

Possible complications include:

• Chest pain
• Labored breathing
• Fever
• Redness or swelling at the incision sites
• Discomfort swallowing
• Fluid buildup around the heart (pericarditis)
• Bleeding

If you experience any of these symptoms or have reason to believe that you’re developing an underlying condition, contact your physician immediately.