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Convergent Ablation Procedure

Posted by BeachBill 
Convergent Ablation Procedure
June 29, 2018 05:03PM
Does anyone have experience with this ablation procedure?
Re: Convergent Ablation Procedure
June 30, 2018 09:25PM
I believe Shannon said they had a lab for this in Dr. Natale's hospital in Austin. However I don't recall anyone actually having the operation and reporting here.
Re: Convergent Ablation Procedure
July 01, 2018 04:19AM
Re: Convergent Ablation Procedure
July 01, 2018 11:29AM

Thanks. Good read.
Re: Convergent Ablation Procedure
July 02, 2018 02:48AM
Hi Beach Bill,.

The convergent procedure is not as consistently effective as Natale's all endocardial approach for persistent and LSPAF ablation with many thousands more patients having undergone successful Natale Extended PVAI plus Posterior Wall Isolation, SVC Isolation and Non-PV trigger detection and ablation along with, as needed, LAA/CS isolation, and as underscored in the BELIEF randomized controlled trial and a growing number of excellent studies emphasizing the wisdom of this approach.

These hybrid procedures are mainly used now for folks with serious obesity in which it can be difficulty to get effective Xray fluoroscopy imagery in some sectors of the left and right atria due to excessive upper torso adipose deposits in and around the heart area.

The recovery for most mini-maze and hybrid AFIB ablation procedures is far and away more difficult and, at times a very tough and drawn out experience during the first month or two post hybrid or maze procedure.

And just as often as with advanced endocardial ablation, an atypical left flutter circuit will also form after a hybrid/maze surgical ablation, and that then needs a follow-up procedure in any event. Alas, not a single cardiac surgeon that I know of performs endocardial Atypical left flutter ablation, so they have to farm that out to another EP.

So often, mini-maze and full maze surgeons down play their atypical left flutter ablation issues post maze, mini-maze or other hybrid procedures (such as the convergence procedure that is one form of an hybrid ablation, which includes both a CV Surgeon and an EP endocardial ablationist.)

And a good many cardiac surgeons doing mini-maze procedures dont list the left atrial flutters their patients will have to deal and most often focus mostly on just the AFIB results.

Instead, a some surgeons will only list their 'Freedom from AFIB (only)" with little to no mention in their ablation stats about these pesky left atrial flutters ... or at least dont emphasize the likelihood of needing a left flutter ablation

Some surgeons downplay the left flutter ablation as if it is just a minor side show, but it is not uncommon, and for EPs recruited for doing such atypical flutters after a mini-maze, you have to be sure they are highly experienced in chasing down such atypical left flutter circuits, which is no piece of cake, and especially for those EPs who do not perform thousands of them. Right-sided typical CTI Flutter and SVT ablations in the right atria only, such as AVNRT-SVT are generally far far easier than most atypical left atrial ablation.

As such, it makes far better common sense, in my book, to start out with a real maestro high volume endocardial ablation expert with world-renown for their expertise and consistent track record for successfully restoring durable freedom from all atrial arrhythmia's. In general, needing one to two procedures, and more rarely three endocardial ablations) when the advanced AFIB/Flutter patient starts their expert ablation process with such an elite operator, to achieve true freedom from all Arrhythmia and off all AAR drugs.

Going this route first, also makes all the sense in the world for reducing the physical stress and long recovery of surgical ablations, unless one is seriously obese and/or has some other risk factors that make a hybrid ablation worth considering up-front and I know of very few such risk factors that would qualify that cannot be dealt with just as effectively, if not more so, with a truly top-tier endocaridal catheter ablationist whose majority caseload is made-up of persistent and LSPAF patients. And all with a lot less physical trauma overall.


Edited 1 time(s). Last edit at 07/02/2018 03:09AM by Shannon.
Re: Convergent Ablation Procedure
July 04, 2018 01:07PM
Thanks Shannon for this information.
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