Isabella
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Isabella, January 17,  2018  5:03am EST

Convergent Hybrid Ablation Procedure

I am a 66-year old female who has been diagnosed with paroxysmal AFIB (4 major episodes in the past 2 years) that took me to ER.  My cardiologist referred me to a Electrophysiologist Cardiologist and this EP is recommending the convergent-hybrid Ablation procedure.  He says that with paroxysmal AFIB I am a good candidate for this procedure and that there is a 90% chance that it will be successful in fixing my AFIB.  The goal is to eventually get me off of my Diltiazem and Sotalol and xarelto.  This procedure is a two-step process.  First step will be a minimally invasive procedure where a cardiothoracic surgeon will do an incision in the area of the sternum and ablate the outside of the heart.  I will stay in the hospital for 3 to 4 days.  6 weeks later, the EP will go through the groin and ablate the inside of the heart, with a overnight hospital stay.  I would like to hear from anyone who has had this procedure.  Was it successful?  Pros and cons, experiences, etc?t


7 Replies
  • Mellanie at StopAfib.org
    Mellanie at StopAfib.org, January 18,  2018  3:56am EST
    Isabella,I am not aware of anyone currently on the forum who has had the Convergent Procedure. And, once people are afib-free from surgical procedures, they often move on with their lives and no longer hang around afib forums. Mellanie
  • Mellanie at StopAfib.org
    Mellanie at StopAfib.org, January 20,  2018  5:45am EST
    There are several things to consider that make the results from the study that was referenced different from Isabella's situation (it's like comparing apples and oranges):Isabella has paroxysmal afib of short duration and minimal burden (4 episodes over 2 years) whereas those in this study all had persistent or longstanding persistent afib, which means being in continuous afib for up to a year (persistent means less than one year), and many much longer (longstanding persistent means longer than a year). This study indicates that AVERAGE AF duration is 7.6 years. That means the buildup of a lot of structural remodeling and electrical remodeling in the atria, whereas with Isabella having had just 4 episodes, there should be little to no remodeling to deal with. Many of these patients had large (even huge) atria and/or failed ablations (these patients were chosen specifically because they had large atria, failed ablations, or long duration of AF), so comparing this to Isabella's case is totally unreasonable!  This study indicates that prior small US and European studies had shown 80% success at three years. Those studies are older, and the technology and techniques have advanced since those studies. Finally, failure of catheter or surgical ablation has been standardized at 30 seconds of afib after the 3-month blanking period, which is not considered a reasonable yardstick any more. (The CABANA study is expected to yield a more reasonable yardstick for future use.)  If a person had 31 seconds of AF in 3 years, they were considered a failure, whereas most of us would consider just having 31 seconds of AF over 3 years to be a success.Thus, let's trust that Isabella's doctor knows what he is talking about and that due to her situation, she is likely to have a 90% success rate. I would never compare her situation to this particular study (especially since this center was new to the procedure and likely has the impact of the learning curve as well). Centers with a lot of convergent procedures under their belts have high success rates.Mellanie
  • JohnLewi
    JohnLewi, September 2,  2018  1:29pm EST

    Hey, John Lewis here. I’m 70 years old and have been living with AFib for 18 years. I had two previous standard ablations. Medicine stopped working for me. So, on August 9, 2018 I had the convergent hybrid ablation. It was performed at the Heart and Vascular Institute at the Washington Hospital Center in Washington DC

    Doctor Christian Schults is my Cardiac Surgeon and Doctor Sung Lee is my Electrophysiologist. 

    I had a 4 day stay in the hospital. Excellent care by the Doctors, nurses etc.The Washington Hospital Center is connected to the Cleveland Clinic and is a MedStar Hospital. 

    Eventhough the procedure is called minimally invasive, I feel that it was very involved. I had a total of 7 incisions For instruments and two drains.

    My Xiphoid bone at the base of my sternum was removed and the connecting muscles somehow re-attached

    I’m three weeks out. Walking some each day. Incisions are healing. Still having abdominal pain from muscle soreness. But getting better. It’s been a slow process but i’m Glad that I’ve had it done. My only other option was a Pacemaker  but my Electrophysiologist wanted to make this my 2nd option and I agreed.

    It should take about 2 months for the scar tissue to form and permanently block the erratic electrical impulses. The outside of my heart was burned 25 times but haven’t been told yet about the inside of my heart.

    I’m on 12.5 mg of Metoprolol  once a day. My blood pressure is in the 118/70 range. Some measurements have been 132/72. Best of all NO AFIB

    Seeing the Surgeon and Electrophysiologist this week of September 2.

    I gave the hospital permission to film and document my procedure as a teaching tool. 

    My email is jflewis48@yahoo.com, if anyone wants to contact me.

    Hope that this is of help to someone.

    Happy Trails - John Lewis

     

  • JohnMiosh
    JohnMiosh, September 3,  2018  3:14am EST

    I had this in the UK last year as part of a research project.  In April I had the minimaze with an atriclip fitted to the LAA.  I agree with John above; it is only minimally invasive if compared to the alternative of open heart surgery.  I had a three day stay in hospital and two and a half weeks off work.  I felt like I had been hit by a truck, but I was able to walk half a mile on day three and quickly returned to normal.  

    My catheter ablation was six months later.  I had an overnight stay in hospital, but only because tbe ablation was completed late in the afternoon.  I felt wonderful immediately afterwards; I had a week off work but culd have returned after a couple of days.

    I had a few short episodes of AF after the first ablation, and nothing since the second (I have had a few unusual traces on the Kardia, but pretty much all recorded as normal.)  Cardiologist says 80% chance of remaining AF free for 20 years.  I personally think this is a little optimistic, but all good so far.

    (Edited multiple typos.  Typed on phone this morning)

     

  • MellanieSAF
    MellanieSAF, September 3,  2018  10:04am EST

    John Lewis and John Miosh,

    Just for clarity's sake, what you two had were vastly different procedures. 

    1) John Lewis' procedure is a convergent hybrid ablation where the access is sub-xiphoid (through the diaphragm area). The catheter ablation is generally done on the same day. The surgical device used is a radiofrequency suction-type device from nContact (nContact was purchased by AtriCure 2-3 years ago). In this procedure, the left atrial appendage is not currently accessible, so is not usually addressed (though I think that may change in the not-too-distant future).

    2) John Miosh's procedure was most likely the hybrid procedure using a Totally Thoracoscopic Maze (TTM), with access under the arms and in the rib cage on both sides. It requires deflating the lungs, one at a time. To make it a hybrid, catheter ablation is typically done 3-6 months later. The surgical device is the bipolar radiofrequency clamp, the original device from AtriCure. In this procedure, the left atrial appendage can be clamped off using the AtriClip.

    Both being called hybrids makes them confusing, but they are vastly different procedures.  

    Mellanie

  • JohnMiosh
    JohnMiosh, September 4,  2018  3:30am EST

    Mellanie is correct, mine was the TTM followed by the catheter. I had assumed the convergent  procedure was similar to my own, but with both parts done at the same time.  I see now that the access is different. 

    The OP was asking about pros and cons.  In my own case the main negative was the recovery time from the TTM; I found it difficult although I was extremely fit (the cause of my AF).  I thought someone more infirm would not cope well, and said at the tome that I wouldn't personally recommend it unless the research showed major benefits over cathter ablation.  From the description I have read about chest access for the convergent procedure, it seems it is possible that this may be worse.

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