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Convergent Ablation And Minimally Invasive Left Atrial Appendage Closure In Persistent Atrial Fibrillation, Two Year Outcomes
Michal Szlapka, Rodolfo Siordia-Dawson, Inka Klonz, Vladimir Vulevic, Stanislav Tsvelodub, Konstantin Krieger, Boris A. Hoffmann, Thorsten Hanke;
Asklepios Harburg, Hamburg, Germany
BACKGROUND:The Convergent Ablation procedure for treatment of persistent atrial fibrillation (Afib) continues gaining strength as a hybrid option offering the best of both worlds: minimally invasive heart surgery plus electrophysiological intervention. Left atrial appendage closure (LAAC) is an established therapy targeted at stroke risk reduction and prevention in patients with A-fib. Recently, electrical LAA isolation gains increasing attention in treating persistent AF. We present our two-year outcomes of a single-center experience after Convergent Ablation procedure with concomitant LAAC and electrical isolation (EI).
METHODS: patients were followed up in 3, 6 and 12 month intervals with 24 h Holter in accordance to HRS consensus paper.Surgical steps: subxyphoid incision → epicardial ablation of posterior left atrial wall → thoracoscopic LAA clip closure.Primary end-point: freedom from Afib at one year after the procedure.Secondary end-point: perioperative and 30-day mortality, complications, such as: bleeding/tamponade, stroke, conversion to sternotomy, wound infection, in-hospital length of stay and readmission.
RESULTS: See Table 1. CONCLUSIONS:The Convergent procedure combined with minimally invasive LAAC/EI proved an effective and safe treatment for symptomatic persistent/long standing persistent Afib, restored sinus rhythm, and improved the quality of life (at two years postoperatively). The length of in-hospital stay and readmission rates decreased significantly.The addition of left atrial appendage and electrical isolation/closure improved ablation effectiveness and reduced postoperative stroke rate despite cessation of anticoagulation therapy.
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