Novel procedure shows promising results as treatment for persistent AF

Issue: February 2012

BOSTON — Results of two studies presented here suggest that the multidisciplinary Convergent Procedure, which employs epicardial and endocardial ablation, may be a successful treatment option for patients with persistent and longstanding persistent atrial fibrillation.

Keith Golden, MD, of St. Vincent Hospital in Indianapolis, and colleagues reported outcomes of a multicenter, retrospective study that included 115 patients (mean AF duration, 5 years) who underwent the Convergent Procedure, enabled by the Numeris Coagulation System with VisiTrax (nContact) for the epicardial ablation portion of the procedure, at four US centers. Ninety-six patients (84%) had persistent or longstanding persistent AF. During the procedure, a surgeon created linear epicardial lesions and an electrophysiologist completed the lines of block endocardially. The patients were followed by 72-hour Holter monitors for at least 6 months after the procedure (mean follow-up, 11.4 months).

No operative or perioperative mortality was reported. Perioperative complications included one (0.9%) transient ischemic attack, two (1.7%) pericardial effusions and two (1.7%) bleeds requiring transfusion. No pacemakers were required during the perioperative period; six patients (5.3%) required pacemakers more than 30 days after the procedure.

Sixty-two patients (64%) were in sinus rhythm without antiarrhythmic drugs after the procedure. When patients taking antiarrhythmic drugs were included in the analysis, 81 patients (84%) were in sinus rhythm. Four patients (4%) underwent repeat ablation procedures at the last follow-up. The researchers said, because there are no protocols for taking patients off of antiarrhythmic drugs, it is important to note that 72 patients (77%) were in sinus rhythm and not undergoing antiarrhythmic drug treatment or with no change in antiarrhythmic drug prophylaxis.

The level of complications reported in this study are similar to rates reported in previously published analyses of traditional AF ablation, the researchers concluded.

“We believe the multidisciplinary procedure offers a comprehensive approach that neither discipline can attain individually. It has substantially reduced EP procedure times, complexity and the amount of ablation required,” Jeffrey Olson, DO, FACC, researcher and EP cardiologist who has been a primary contributor to the Convergent Procedure experience at St. Vincent Hospital, said in a news release.

In another study, Borut Gersak, MD, PhD, head of the department of CV surgery at University Medical Center in Ljubljana, Slovenia, and colleagues analyzed 50 consecutive patients who underwent the Convergent Procedure and also had Reveal XT monitors implanted to continuously record rhythm status.

The researchers reported no operative mortality during follow-up. After the procedure, 91% of patients were in sinus rhythm at 6 months; 95% at 12 months; and 87% at 24 months. Data recorded with the Reveal XT monitors showed AF burden of ≤3% in 79% of patients at 6 months, in 90% of patients at 12 months and in 87% of patients at 24 months. Among patients not taking any antiarrhythmic drugs, 80% had AF burden of no more than 3% at 1-year follow-up; 80% of patients had AF burden of ≤1% (14 minutes per day) at 1-year follow-up, with 75% having an AF burden of ≤1% while taking antiarrhythmic drugs and not requiring any repeat catheter ablation.

“These results are extremely important because this continued monitoring shows us that the patients who were in AF burden less than 1% or 3% per day can be defined as a success,” Gersak told Cardiology Today. – by Casey Murphy

For more information:

Gersak B. Poster #BAFS2012-10.
Golden K. Poster #BAF2012-20. Both presented at: The 17th Annual International Boston AF Symposium; Jan. 12-14, 2012; Boston.

Disclosure: Dr. Gersak is a consultant for nContact Inc. and Medtronic. Dr. Golden has received research support from nContact Inc. Dr. Olson has received research support from and is a consultant for nContact Inc.

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