Convergent Procedure

What is a Convergent procedure?

A Convergent procedure combines a minimally invasive surgical procedure with a catheter ablation. This hybrid procedure treats atrial fibrillation (Afib) that is advanced or persistent. About 70% of the 33 million people with atrial fibrillation in the world have this type. Your healthcare provider may use this procedure if your Afib keeps coming back even if you’ve tried medicine and a catheter ablation.

Providers who are experts in surgery and catheter ablation create scars that stop abnormal electrical activity in your heart’s upper chambers (atria). A Convergent ablation procedure uses energy to destroy certain tissues inside and outside of your heart.

How should I prepare for a Convergent procedure?

You’ll need to stop taking anticoagulants several days before your Convergent procedure for Afib. The number of days depends on the type of blood thinner you’re taking. Ask your healthcare provider which medicines to stop taking before surgery and when. Don’t stop taking any medicines unless your provider tells you to stop.

You’ll also need to fast (stop eating and drinking) at a certain time. Check with your provider to see when you need to fast before surgery.

Talk to your providers about whether you’ll have both parts of your procedure on the same day or not. They could perform them four weeks apart or more.

What happens during the procedure?

Here’s what happens during a Convergent procedure for atrial fibrillation:

1. A healthcare provider gives you general anesthesia so you’ll sleep and won’t feel pain.
2. A cardiothoracic surgeon makes a cut below the bottom of your breastbone (sternum). The cut is about 3 to 4 centimeters (1 to 1.5 inches) long.
3. They cut through the pericardium, or sac around the outside of your heart.
4. They insert an endoscope to help them see.
5. A surgeon uses a catheter (thin tube with wires that carry energy) to ablate (damage) certain areas of the outside of your heart. These areas include your left atrium’s back wall and openings to your pulmonary veins. This part of the procedure can take 60 to 90 minutes.
6. A surgeon puts a short-term drain in your chest and closes the cut.
7. Sometimes, a surgeon also closes off your left atrial appendage to help reduce your risk of stroke. This extra step makes it a “Convergent Plus” procedure.

The second part of the Convergent procedure involves a second catheter ablation. An electrophysiologist uses a catheter that goes through a blood vessel in your groin and up to your heart. The provider ablates the inside of your heart, treating spots that are harder to reach from outside your heart. This part may happen six weeks later in a separate procedure. If so, you’ll have moderate sedation or general anesthesia during it.

How long does a Convergent ablation procedure take?

A Convergent procedure for atrial fibrillation takes an average of three hours. It’ll take longer if you have a Convergent Plus procedure.

What happens after a Convergent procedure?

A healthcare provider may give you medicines after your procedure. These may include steroids to prevent inflammation.

You’ll have follow-up visits with your provider after your procedure. You may receive a Holter monitor at some of these appointments. The monitor can give your provider a recording of your heart’s electrical activity for hours or days at a time. This can tell them if you’re having any atrial fibrillation.

What are the benefits of a Convergent procedure for Afib?

The benefits of a Convergent procedure include:

• It works better than a catheter ablation alone, which only treats tissue inside your heart.
• It puts your esophagus at a lower risk of injury. This is because a healthcare provider can direct the ablation away from your esophagus.
• It doesn’t require you to be on cardiopulmonary bypass.

What is the success rate of Convergent ablation for atrial fibrillation?

The success rate for the Convergent procedure was at least 65% in a 2020 clinical trial. Since then, providers have reported success rates as high as 83% and 95% a year after the procedure. They defined success as freedom from atrial fibrillation or medicines that prevent arrhythmia.

What are the risks or complications?

Risks or complications of a Convergent procedure may include:

• Cough
• Fatigue
• Shortness of breath
• Stroke
• Bleeding
• Pericardial effusion (extra fluid around your heart)
• Nerve injury
• Transient ischemic attack (TIA)

What is the recovery time?

After the surgical part of the Convergent procedure, you’ll stay in the hospital for one or two days. If you need the second part of the procedure, a provider may perform it after three months.

You’ll need to have follow-up appointments three weeks after surgery and three, six and 12 months after that. Then you’ll return once a year so a provider can check your heart rhythm.

When should I call my healthcare provider?

Contact your healthcare provider if your symptoms of atrial fibrillation come back. You should also let them know if you have bleeding or an infection around your incision.