Epicardial Box Lesion Using Bipolar Biparietal Radiofrequency and Multimodality Scar Evaluation - a case series

Abstract Background Surgical epicardial AF ablation can be performed as a stand-alone (thoracoscopic) procedure or concomitant to other cardiac surgery. In hybrid AF ablation thoracoscopic surgical epicardial ablation is combined with a percutaneous endocardial ablation. The Medtronic Gemini-S clamp is a surgical tool that uses irrigated bipolar biparietal RF energy applied with two clamp lesions that overlap to create one epicardial box lesion including the posterior LA wall and the pulmonary veins. Case summary We describe three patients with therapy-refractory persistent AF and different stages of atrial remodelling in whom the Medtronic Cardioblate Gemini-S Irrigated RF Surgical Ablation System was used for hybrid AF ablation. Acute endocardial validation at the end of the hybrid ablation revealed a complete box lesion in all three cases. At 2-year follow-up, two out of three patients had recurrence of atrial arrhythmias. Invasive electro-anatomical mapping confirmed persistence of the box lesion, and the mechanism of arrhythmia recurrence in both patients was unrelated to posterior left atrium or the pulmonary veins. The third patient has been without arrhythmia symptoms since the ablation procedure. A 3D late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) illustrates the ablation scar non-invasively in two cases. Discussion Thoracoscopic biparietal RF AF ablation with the Medtronic Cardioblate Gemini-S Irrigated RF Surgical Ablation System results in permanent transmural scar formation, irrespective of the stage of atrial remodelling, as shown in this small population by means of multimodality scar evaluation.

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Robot-assisted MRI-guided prostatic interventions

Robotica ◽

10.1017/s026357470999066x ◽

2009 ◽

Vol 28 (2) ◽

pp. 215-234 ◽

Cited By ~ 22

Author(s):

Andrew A. Goldenberg ◽

John Trachtenberg ◽

Yang Yi ◽

Robert Weersink ◽

Marshall S. Sussman ◽

...

Keyword(s):

Thermal Ablation ◽

Pulse Sequences ◽

Robot Assisted ◽

Surgical Ablation ◽

Image Guided ◽

Surgical Tool ◽

Mri Environment ◽

Focal Ablation ◽

Mri Guided ◽

Magnetic Resonance Imaging Mri

SUMMARYThis paper reports on recent progress made toward the development of a new magnetic resonance imaging (MRI)-compatible robot-assisted surgical system for closed-bore image-guided prostatic interventions: thermal ablation, radioactive seed implants (brachytherapy), and biopsy. Each type of intervention will be performed with a different image-guided, robot-based surgical tool mounted on the same MRI-guided robot through a modular trocar. The first stage of this development addresses only laser-based focal ablation. The robot mechanical structure, modular surgical trocar, control architecture, and current stage of performance evaluation in the MRI environment are presented. The robot actuators are ultrasonic motors. A methodology of using such motors in the MRI environment is presented. The robot prototype with surgical ablation tool is undergoing tests on phantoms in the MRI bore. The tests cover MRI compatibility, image visualization, robot accuracy, and thermal mapping. To date, (i) the images are artifact- and noise-free for certain scanning pulse sequences; (ii) the robot tip positioning error is less than 1.2 mm even at positions closer than 0.3 m from the MRI isocenter; (iii) penetration toward the target is image-monitored in near-real time; and (iv) thermal ablation and temperature mapping are achieved using a laser delivered on an optical fiber and MRI, respectively.

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Postarthroscopy Imaging in Femoroacetabular Impingement: Persistent Pain May Be Due to an Insufficient Correction of Preoperative Abnormalities

Joints ◽

10.1055/s-0037-1601411 ◽

2017 ◽

Vol 05 (01) ◽

pp. 021-026 ◽

Cited By ~ 1

Author(s):

Cosimo Tudisco ◽

Salvatore Bisicchia ◽

Sandro Tormenta ◽

Amedeo Taglieri ◽

Ezio Fanucci

Keyword(s):

Case Series ◽

Persistent Pain ◽

Retrospective Case ◽

Level Of Evidence ◽

Mean Values ◽

Center Edge ◽

Patient Groups ◽

The Mean ◽

Magnetic Resonance Imaging Mri

Purpose The purpose of this study was to evaluate the effect of correction of abnormal radiographic parameters on postoperative pain in a group of patients treated arthroscopically for femoracetabular impingement (FAI). Methods A retrospective study was performed on 23 patients affected by mixed-type FAI and treated arthroscopically. There were 11 males and 12 females with a mean age of 46.5 (range: 28–67) years. Center-edge (CE) and α angles were measured on preoperative and postoperative radiographic and magnetic resonance imaging (MRI) studies and were correlated with persistent pain at follow-up. Results The mean preoperative CE and α angles were 38.6 ± 5.2 and 67.3 ± 7.2 degrees, respectively. At follow-up, in the 17 pain-free patients, the mean pre- and postoperative CE angle were 38.1 ± 5.6 and 32.6 ± 4.8 degrees, respectively, whereas the mean pre- and postoperative α angles at MRI were 66.3 ± 7.9 and 47.9 ± 8.9 degrees, respectively. In six patients with persistent hip pain, the mean pre- and postoperative CE angles were 39.8 ± 3.6 and 35.8 ± 3.1 degrees, respectively, whereas the mean pre- and postoperative α angles were 70.0 ± 3.9 and 58.8 ± 2.6 degrees, respectively. Mean values of all the analyzed radiological parameters, except CE angle in patients with pain, improved significantly after surgery. On comparing patient groups, significantly lower postoperative α angles and lower CE angle were observed in patients without pain. Conclusion In case of persistent pain after arthroscopic treatment of FAI, a new set of imaging studies must be performed because pain may be related to an insufficient correction of preoperative radiographic abnormalities. Level of Evidence Level IV, retrospective case series.

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Abstract 16237: Zero Fluoroscopy Ablation of Atrial Fibrillation: A Safety and Feasibility Study

Circulation ◽

10.1161/circ.130.suppl_2.16237 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Luigi Di Biase ◽

Rodney Horton ◽

Chintan Trivedi ◽

Prasant Mohanty ◽

Sanghamitra Mohanty ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Pulmonary Veins ◽

Radiation Risk ◽

Control Group ◽

Short Term ◽

Af Ablation ◽

And Control ◽

Zero Fluoroscopy

Introduction: Radiofrequency catheter ablation of atrial fibrillation is performed under fluoroscopic guidance and therefore carries radiation risk exposure for the both the patient and the operator. Three-dimensional mapping systems and newer technologies to allow non-fluoroscopic catheter visualization together with intracardiac echo have reduced but not abolished the fluoroscopy exposure. We aim to demonstrate the feasibility, the safety and the efficacy of catheter ablation for atrial fibrillation without the use of fluoroscopy. Methods: A totally fluoro-less approach was developed for AF ablation at our Institution. 94 consecutive AF patients underwent zero fluoroscopy catheter ablation for atrial fibrillation. In the zero fluoroscopy cases, the fluoroscopy arm was kept far away from the patient table. Access including double trans-septal, mapping with the Carto 3 system and ablation were all performed without fluoroscopy with the use of ICE and the Carto 3 system. These 94 patients were compared with 94 control patients matched for age, sex and type of AF who underwent AF ablation by the same operator with the use of fluoroscopy. Results: Baseline characteristics were similar between fluoroless (N=94, Age=64.5 ± 10.1, 75.5% male, 48% paroxysmal) and control (N=94, Age=65.1 ± 9.9, 72.3% male, 50% paroxysmal) group. Non-PV triggers were detected and ablated in 51 (54.3%) and 56 (59.6%) patients in fluoroless and control group respectively (p=0.5). Average fluoro time in control group was 10.1 ± 4.7 minutes. Procedure duration was comparable (120.4 ± 25.8 vs. 122.2 ± 28.7, p =0.6). After the short term median follow-up of 4.5 (4 – 6.5) months, 10 (10.6 %) patients in flourless and 9 (9.6%) patients in control group experienced recurrences (p=0.8).One pericardial effusion requiring pericardiocenteis occurred in the fluoroless group. Conclusions: Our series show that zero fluoroscopy ablation of atrial fibrillation with the use of newer technologies is feasible, safe and efficacious at the short term follow up. Importantly in our series the double transeptal was performed without fluoroscopy and the ablation was not limited to the pulmonary veins only but included ablation of the posterior wall, the coronary sinus and the left atrial appendage.

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Surgical Ablation for Atrial Fibrillation in Cardiac Surgery a Meta-Analysis and Systematic Review

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3181d9199b ◽

2010 ◽

Vol 5 (2) ◽

pp. 84-96 ◽

Cited By ~ 49

Author(s):

Davy C. H. Cheng ◽

Niv Ad ◽

Janet Martin ◽

Eva E. Berglin ◽

Byung-Chul Chang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Sinus Rhythm ◽

Resource Utilization ◽

Meta Analysis ◽

Surgical Ablation ◽

Af Ablation ◽

All Cause Mortality ◽

Meta Regression

Objectives This meta-analysis sought to determine whether surgical ablation improves clinical outcomes and resource utilization compared with no ablation in adult patients with persistent and permanent atrial fibrillation (AF) undergoing cardiac surgery. Methods A comprehensive search was undertaken to identify all randomized (RCT) and nonrandomized (non-RCT) controlled trials of surgical ablation versus no ablation in patients with AF undergoing cardiac surgery up to April 2009. The primary outcome was sinus rhythm. Secondary outcomes included survival and any other reported clinically relevant outcome or indicator of resource utilization. Odds ratios (OR) and weighted mean differences (WMD) and their 95% confidence intervals (95% CI) were analyzed as appropriate using the random effects model. Heterogeneity was measured using the I2 statistic. Meta-regression was performed to explore the relationship between the benefit from surgical AF and duration of follow-up. Results Thirty-three studies met the inclusion criteria (10 RCTs and 23 non-RCTs) for a total of 4647 patients. The number of patients in sinus rhythm was significantly improved at discharge in the surgical AF ablation group versus (68.6%) the surgery alone group (23.0%) in RCTs (OR 10.1, 95% CI 4.5–22.5) and non-RCTs (OR 7.15, 95% CI 3.42–14.95). This effect on sinus rhythm (74.6% vs. 18.4%) remained at follow-up of 1 to 5 years (OR 6.7, 95% CI 2.8–15.7 for RCT, and OR 15.5, 95% CI 6.6–36.7 for non-RCT). The risk of all-cause mortality at 30 days was not different between the groups in RCT (OR 1.20, 95% CI 0.52–3.16) or non-RCT studies (OR 0.99, 95% CI 0.52–1.87). In studies reporting all-cause mortality at 1 year or more (up to 5 years), mortality did not differ in RCT studies (OR 1.21, 95% CI 0.59–2.51) but was significantly reduced in non-RCT studies (OR 0.54, 95% CI 0.31–0.96). Stroke incidence was not reduced significantly; however, in meta-regression, the risk of stroke decreased significantly with longer follow-up. Other clinical outcomes were similar between groups. Operation time was significantly increased with surgical AF ablation; however, overall impact on length of stay was variable. Conclusions In patients with persistent or permanent AF who present for cardiac surgery, the addition of surgical AF ablation led to a significantly higher rate of sinus rhythm in RCT and non-RCT studies compared with cardiac surgery alone, and this effect remains robust over the longer term (1–5 years). Although non-RCT studies suggest the possibility of reduced risk of stroke and death, this remains to be proven in prospective RCTs with adequate power and follow-up.

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Silk Vista Baby Is a Safe and Technically Feasible Flow Diverting Stent for Distal Aneurysm Treatment

Frontiers in Neurology ◽

10.3389/fneur.2021.676749 ◽

2021 ◽

Vol 12 ◽

Author(s):

Vladimir Gavrilovic ◽

Annarita Dapoto ◽

Nicola Marotti ◽

Andrea Pellegrin ◽

Alessandro Pauro ◽

...

Keyword(s):

Case Series ◽

Flow Diverter ◽

Side Branch ◽

University Hospital ◽

Complete Occlusion ◽

Magnetic Resonance Imaging Mri ◽

The University ◽

Santa Maria ◽

Flow Diverting Stent

Background and Purpose: Flow diverting stents are designed to divert blood flow from the aneurysm sac, allowing for eventual occlusion following endovascular therapy. This case series reports clinical experience using the Silk Vista Baby (SVB, Balt Extrusion, Montmorency, France), a flow diverter (FD) designed to treat intracranial aneurysms in small, distal vessels.Methods: All patients who underwent treatment with SVB at the University Hospital “Santa Maria della Misericordia” of Udine between July 2018 and September 2020 were retrospectively identified. Baseline patient and aneurysm characteristics, intraprocedural technical outcomes, periprocedural complications, modified Rankin Scale (mRS) at discharge, magnetic resonance imaging (MRI) results at 3-month follow-up, and angiographic results at 6-month follow-up were collected.Results: A total of 18 patients (55.6% [10/18] male; mean age 62.6 years, range: 42–77 years) were retrospectively identified, receiving treatment for 22 aneurysms. Most patients were symptomatic (14/18, 77.8%) and approximately half had subarachnoid hemorrhage (10/18, 55.6%). Sufficient aneurysm coverage was achieved in 88.9% (16/18) of patients with a single device. Mortality did not occur (0/18, 0%); adverse device-related events included side branch occlusion (1/18, 5.6%) and in-stent thrombosis (1/18, 5.6%). At discharge, 77.8% (14/18) had an mRS of 0. In most cases, patients showed complete occlusion (10/15, 66.7%) or a small aneurysmal remnant (3/15, 20.0%) upon MRI; upon angiography, most showed complete occlusion (10/13, 76.9%) or only a small aneurysmal remnant (2/13, 15.4%).Conclusion: This case series showed that the SVB FD is safe and feasible to use in patients with aneurysms in small, distal vessels. Additional randomized, prospective studies with larger cohorts are needed for the SVB.

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Arthroscopic Meniscopexy for the Treatment of Nontraumatic Osteochondritis Dissecans in the Knee Joint of Adult Patients

Cartilage ◽

10.1177/1947603518800541 ◽

2018 ◽

Vol 11 (4) ◽

pp. 441-446

Author(s):

Fabian Blanke ◽

Andreas Feitenhansl ◽

Maximilian Haenle ◽

Stephan Vogt

Keyword(s):

Knee Joint ◽

Osteochondritis Dissecans ◽

Case Series ◽

Complete Healing ◽

Lysholm Score ◽

Anterior Horn ◽

Grade Ii ◽

Magnetic Resonance Imaging Mri ◽

Knee Pathology

Objective The etiology of osteochondritis dissecans (OCD) is still uncertain. Recently, it has been hypothesized that instability of the anterior horn of the meniscus is an important cause for the development of a nontraumatic OCD in adolescents with good results after surgical stabilization. This case series aims to evaluate the treatment results after meniscus stabilization in adults with nontraumatic OCD. Design Ten patients with magnetic resonance imaging (MRI)-confirmed OCD of the knee joint, meniscal instability, and closed epiphyseal plates were enrolled in this study. The instable meniscus was stabilized by direct suturing of the anterior horn of the meniscus. MRI examinations were performed preoperative and 6 and 12 months postoperative. The OCD was classified arthroscopically according to Guhl and according to Hughes in the MRI. The overall knee function was evaluated by the Lysholm score before treatment and 12 months postoperative. Results Four women and 6 men with a mean age of 20.6 ± 1.9 years were included in this study. Preoperatively 60% of the patients showed a grade II or III lesion arthroscopically and 70% a grade III or IVa lesion in the MRI examination. After arthroscopic meniscus stabilization the Lysholm score increased in average from 48.1 ± 14.12 before treatment to 97.5 ± 3.1 postoperative. At final follow-up after 12 months, an improvement of the OCD in the MRI could be demonstrated in all patients (100%). In 80% of the patients a complete healing of the OCD could be noted. Conclusion The clinical concept of an instable anterior horn of the meniscus as a cause for the development of a nontraumatic OCD seems to be transferable to adults and arthroscopic stabilization can lead to a sufficient healing of this knee pathology.

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SURGICAL TREATMENT OF ATRIAL FIBRILLATION IN ELDERLY PATIENTS UNDERGOING HIGH RISK CARDIAC SURGERY

10.22541/au.162214407.72009074/v1 ◽

2021 ◽

Author(s):

Mohsin Uzzaman ◽

Imthiaz Manoly ◽

Mohini Panikkar ◽

Maciej Matuszewski ◽

Nicolas Nikolaidis ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Surgical Treatment ◽

High Risk ◽

Elderly Patients ◽

Control Group ◽

Surgical Ablation ◽

Af Ablation

BACKGROUND/AIM To evaluate outcomes of concurrent Cox-Maze procedures in elderly patients undergoing high-risk cardiac surgery. MEHODS We retrospectively identified patients aged over 70 years with Atrial Fibrillation (AF) from 2011 to 2017 who had two or more other cardiac procedures. They were subdivided into two groups: 1. Cox-Maze IV AF ablation 2. No-Surgical AF treatment. Patients requiring redo procedures or those who had isolated PVI or LAAO were excluded. Heart rhythm assessed from Holter reports or 12-lead ECG. Follow-up data collected through telephone consultations and medical records. RESULTS There were 239 patients. Median follow up was 61 months. 70 patients had Cox-Maze IV procedures (29.3%). Demographic, intra- and post-operative outcomes were similar between groups although duration of pre-operative AF was shorter in Cox-Maze group (p=0.001). One (1.4%) patient in Cox maze group with 30-day mortality compared to 14 (8.2%) the control group (p=0.05). Sinus rhythm at annual and latest follow-up was 84.9% and 80.0% respectively in Maze group - significantly better than No-Surgical AF treatment groups (P<0.001). 160 patients (66.9%) were alive at long-term follow-up with better survival curves in Cox Maze group compared to No-Surgical treatment group (p=0.02). There was significantly higher proportion of patients in NYHA 1 status in Cox-Maze group (p=0.009). No differences observed in freedom from stroke (p=0.80) or permanent pacemaker (p=0.33). CONCLUSIONS. Surgical ablation is beneficial in elderly patients undergoing high-risk surgery - promoting excellent long-term freedom from AF and symptomatic/prognostic benefits. Therefore, surgical risk need not be reason to deny benefits of concomitant AF-ablation.

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Early Outcomes and Complications of Synthetic Cartilage Implant for Treatment of Hallux Rigidus in the United States

Foot & Ankle International ◽

10.1177/1071100719855049 ◽

2019 ◽

Vol 40 (10) ◽

pp. 1140-1148 ◽

Cited By ~ 14

Author(s):

Spenser J. Cassinelli ◽

Stephanie Chen ◽

Timothy P. Charlton ◽

David B. Thordarson

Keyword(s):

Patient Satisfaction ◽

Case Series ◽

Retrospective Chart Review ◽

The United States ◽

Reoperation Rate ◽

Hallux Rigidus ◽

Level Of Evidence ◽

Physical Dysfunction ◽

Magnetic Resonance Imaging Mri

Background: The aim of this study was to determine the early outcomes and complications following the implantation of a hydrogel synthetic cartilage implant (SCI, Cartiva) for the treatment of hallux rigidus by a single surgeon. Methods: A retrospective chart review was performed of consecutive patients who underwent treatment for hallux rigidus with an SCI between August 2016 and April 2018 by a single surgeon. Demographic information, radiographic assessment, and concomitant operative procedures performed were evaluated for all patients. Postoperatively, PROMIS physical function (PF) and pain interference (PI) scores, patient satisfaction, reoperation, conversion to arthrodesis, and need for further clinical treatment were collected. Sixty-four SCIs were implanted in 60 patients. Follow-up averaged 18.5 months (range 12-30 months). Results: 14% (9/64) of patients were very satisfied, 28% (18/64) satisfied, 20% (13/64) neutral, 11% (7/64) unsatisfied, and 27% (17/64) very unsatisfied with their outcome. In addition, 45% of patients underwent additional procedures at the time of SCI, and 23% had a history of surgery on the hallux before implantation. PROMIS PF scores averaged 42 and PROMIS PI scores averaged 60. Overall, 63% completed PROMIS PI, 66% completed PROMIS PF, and 100% completed a satisfaction survey. In addition, 30% (19/64) underwent magnetic resonance imaging (MRI) postoperatively due to pain. There was a 20% reoperation rate, which included an 8% rate of conversion to arthrodesis. Conclusion: Synthetic cartilage implantation yielded neutral patient satisfaction, mild pain, and physical dysfunction at early follow-up. We believe patient selection and counseling regarding early postoperative limitations are important before proceeding with SCI. Level of Evidence: Level IV, case series.

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Outcomes after hemispherectomy in adult patients with intractable epilepsy: institutional experience and systematic review of the literature

Journal of Neurosurgery ◽

10.3171/2016.9.jns151778 ◽

2018 ◽

Vol 128 (3) ◽

pp. 853-861 ◽

Cited By ~ 4

Author(s):

Courtney M. Schusse ◽

Kris Smith ◽

Cornelia Drees

Keyword(s):

Neuropsychological Testing ◽

Case Series ◽

Intractable Epilepsy ◽

Adult Patients ◽

Morbidity Rate ◽

Seizure Outcome ◽

Seizure Freedom ◽

Surgical Tool ◽

Drug Resistant Epilepsy

OBJECTIVEHemispherectomy is a surgical technique that is established as a standard treatment in appropriately selected patients with drug-resistant epilepsy. It has proven to be successful in pediatric patients with unilateral hemispheric lesions but is underutilized in adults. This study retrospectively evaluated the clinical outcomes after hemispherectomy in adult patients with refractory epilepsy.METHODSThis study examined 6 cases of hemispherectomy in adult patients at Barrow Neurological Institute. In addition, all case series of hemispherectomy in adult patients were identified through a literature review using MEDLINE and PubMed. Case series of patients older than 18 years were included; reports of patients without clear follow-up duration or method of validated seizure outcome quantification were excluded. Seizure outcome was based on the Engel classification.RESULTSA total of 90 cases of adult hemispherectomy were identified, including 6 newly added by Barrow Neurological Institute. Sixty-five patients underwent functional hemispherectomy; 25 patients had anatomical hemispherectomy. Length of follow-up ranged from 9 to 456 months. Seizure freedom was achieved in 80% of patients. The overall morbidity rate was low, with 9 patients (10%) having new or additional postoperative speech or language dysfunction, and 19 patients (21%) reporting some worsening of hemiparesis. No patients lost ambulatory or significant functional ability, and 2 patients had objective ambulatory improvement. Among the 41 patients who underwent additional formal neuropsychological testing postoperatively, overall stability or improvement was seen.CONCLUSIONSHemispherectomy is a valuable surgical tool for properly selected adult patients with pre-existing hemiparesis and intractable epilepsy. In published cases, as well as in this series, the procedure has overall been well tolerated without significant morbidity, and the majority of patients have been rendered free of seizures.

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Closed Chest Convergent Epicardial–Endocardial Ablation of Non-paroxysmal Atrial Fibrillation – A Case Series and Literature Review

Arrhythmia & Electrophysiology Review ◽

10.15420/aer.2013.2.1.65 ◽

2013 ◽

Vol 2 (1) ◽

pp. 65 ◽

Cited By ~ 12

Author(s):

Amit J Thosani ◽

Paul Gerczuk ◽

Emerson Liu ◽

William Belden ◽

Robert Moraca ◽

...

Keyword(s):

Atrial Fibrillation ◽

Multidisciplinary Approach ◽

Case Series ◽

Closed Chest ◽

Effective Option ◽

Long Term Follow Up ◽

Cardiac Surgeon ◽

Magnetic Resonance Imaging Mri

The closed chest convergent procedure is a multidisciplinary approach to atrial fibrillation (AF) treatment. Epicardial posterior left atrial (PLA) ablation is performed by a cardiac surgeon using a transdiaphragmatic endoscope, immediately followed by percutaneous pulmonary vein (PV) isolation performed by a cardiac electrophysiologist. Interim outcomes for the treatment of non-paroxysmal AF (NPAF) were evaluated based on peri-procedural safety and complications, freedom from recurrent AF, and need for cardioversion or repeat catheter ablation at three, six and 12 months post-procedure. A total of 43 patients (86 % NPAF) underwent the convergent procedure. Patients were 84 % male, with mean age 58.6 ± 8.7 years. Mean AF duration was 45.4 ± 40.3 months. Pre-procedure left atrium (LA) volumetric data using cardiac magnetic resonance imaging (MRI) or computed tomography (CT) was available for 30 patients (70 %). Average LA volume was 155.5 ± 48.4 millilitres (ml); two-thirds of patients had a LA volume >130 ml. There was no operative or peri-operative mortality. Sinus rhythm (SR) was recorded at three months in 31 of 39 (79 %) patients, at six months in 24 of 27 (89 %) patients and at 12 months in nine patients. The convergent procedure is a safe and effective option for both PV isolation and PLA substrate ablation in NPAF patients. Long-term follow-up is required and randomised clinical trials warranted.

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