The Convergent Atrial Fibrillation Ablation Procedure: Evolution of a Multidisciplinary Approach to Atrial Fibrillation Management

The treatment of AF has evolved over the past decade with increasing use of catheter ablation in patients refractory to medical therapy. While pulmonary vein isolation using endocardial catheter ablation has been successful in paroxysmal AF, the results have been more controversial in patients with long-standing persistent AF where extrapulmonary venous foci are increasingly recognised in the initiation and maintenance of AF. Hybrid ablation is the integration of minimally invasive epicardial ablation with endocardial catheter ablation, and has been increasingly used in this population with better results. The aim of this article was to analyse and discuss the evidence for the integration of catheter and minimally invasive surgical approaches to treat AF with specific focus on convergent ablation and exclusion of the left atrial appendage using a surgically applied clip.

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Energy Sources for the Surgical Treatment of Atrial Fibrillation

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984519878166 ◽

2019 ◽

Vol 14 (6) ◽

pp. 503-508

Author(s):

Robert M. MacGregor ◽

Spencer J. Melby ◽

Richard B. Schuessler ◽

Ralph J. Damiano

Keyword(s):

Atrial Fibrillation ◽

Surgical Treatment ◽

Tissue Injury ◽

Surgical Techniques ◽

Maze Procedure ◽

Energy Sources ◽

Surgical Approaches ◽

Surgical Ablation ◽

The Past ◽

Minimally Invasive Surgical

The surgical treatment of atrial fibrillation has evolved over the past 2 decades due to the advent of ablation technology, and the introduction of less invasive surgical approaches. Current devices produce ablation lines that aim to replace the incisions of traditional surgical ablation strategies, such as the Cox-Maze procedure. This has helped to simplify and shorten surgical ablation procedures and has allowed for the development of minimally invasive surgical techniques. This review discusses surgical ablation energy sources and devices, providing background on device characteristics, mechanism of tissue injury, and success in creating transmural lesions.

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P2652Antiarrhythmic drugs, catheter ablation or minimally-invasive surgical ablation for treating persistent atrial fibrillation: a systematic review and meta-analyses

European Heart Journal ◽

10.1093/eurheartj/ehx502.p2652 ◽

2017 ◽

Vol 38 (suppl_1) ◽

Author(s):

E.R. Meulendijks

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Catheter Ablation ◽

Minimally Invasive ◽

Persistent Atrial Fibrillation ◽

Surgical Ablation ◽

Minimally Invasive Surgical ◽

Meta Analyses

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Minimally Invasive Surgical Therapies for Atrial Fibrillation

ISRN Cardiology ◽

10.5402/2012/606324 ◽

2012 ◽

Vol 2012 ◽

pp. 1-12 ◽

Cited By ~ 5

Author(s):

Yoshitsugu Nakamura ◽

Bob Kiaii ◽

Michael W. A. Chu

Keyword(s):

Atrial Fibrillation ◽

Minimally Invasive ◽

Left Atrial Appendage ◽

Pulmonary Veins ◽

Maze Procedure ◽

Surgical Ablation ◽

Minimally Invasive Surgical ◽

Invasive Techniques ◽

Lower Morbidity ◽

Pharmacologic Therapies

Atrial fibrillation is the most common sustained arrhythmia and is associated with significant risks of thromboembolism, stroke, congestive heart failure, and death. There have been major advances in the management of atrial fibrillation including pharmacologic therapies, antithrombotic therapies, and ablation techniques. Surgery for atrial fibrillation, including both concomitant and stand-alone interventions, is an effective therapy to restore sinus rhythm. Minimally invasive surgical ablation is an emerging field that aims for the superior results of the traditional Cox-Maze procedure through a less invasive operation with lower morbidity, quicker recovery, and improved patient satisfaction. These novel techniques utilize endoscopic or minithoracotomy approaches with various energy sources to achieve electrical isolation of the pulmonary veins in addition to other ablation lines. We review advancements in minimally invasive techniques for atrial fibrillation surgery, including management of the left atrial appendage.

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