In some patients A-Fib comes and goes. This is called paroxysmal A-Fib and is well managed
with medications or with catheter ablation that blocks the electrical impulses from causing the chamber to beat out of sync. In other patients, A-Fib can become persistent (lasting up to a year) or long-standing (greater than a year). When A-Fib becomes more persistent is more difficult to treat. Medications and catheter ablation are less effective in these circumstances.
In the past, the only truly effective treatment for persistent and long-standing persistent A-Fib was a surgical intervention called a
maze procedure. As this procedure requires an open chest surgery it is done almost exclusively when patients require heart surgery for another reason. More recently a procedure has been developed that combines two minimally invasive techniques—one in the cardiovascular operating room and one in the
electrophysiology (EP) lab—to reduce or resolve a patient’s persistent A-Fib. This hybrid
approach is known as the convergent procedure.
The first step of convergent happens in the operating room. The surgeon places tools through a small incision using a tiny camera to ablate—or disrupt the electrical pathways on the back wall of the heart. While in the procedure, the surgeon also places a small clip on the left atrial appendage, which is an out pouching in the heart where blood clots most often form. This helps decrease the risk of stroke. The second step of convergent happens in the EP lab. The electrophysiologist performs a second ablation on the pulmonary veins completing the treatment and restoring normal rhythm in most patients.