Covergent Hybrid Maze Sugery As First Line Invasive HCM AFIB Treatment?

Hey guys. Was hoping for some input here. I'm a 37 M.

I have paroxysmal Afib with rvr. I have HCM and a family history of HCM thus i also have an ICD.


My Afib has gotten progressively more frequent last few years. Last year I had 5 cardioversions with the last one failing. Scheduled a emergency ablation at the local hospital but i converted chemically with amiordrone in the ICU. I've been back home now for 5 months. Afib free so far. Back on my sotalol. I just got insurance back this year so last friday I spent all day at Emory Hospital talking to my EP and heart doctors. Doctors who have recommended a ablation for the past few years.


The hospital and EPs, Thorasic Surgeon Im seeing are located at Emory Hospital in Atlanta Georgia. I go in thinking standard ablation. I'm thinking finally, I can afford to have this done. Well. They drop the bomb that instead of traditional RF ablation my only choice is to get a "Convergent" hybrid ablation. Due my HCM (IHSS) and what he said the stiffening of my heart.

Instead of 2 days at the hospital, its going to be 4 to 6. I'll need general anesthesia instead of conscious sedation and there's more risk involved due to cutting thru my stomach into my heart from a 1inch incision. This approach includes needing a chest drain tube for a few days as well..

My EP was out the day I visited. I talked with his colleagues. They told me I had a option. The surgical Convergent Hybrid or traditional RF ablation. They told me I could do a traditional ablation and could always do the surgical approach later if needed. Come Monday. I call them back to schedule. Told them after research, I opted for the more conservative less invasive approach. That's when they told me, despite was my EPs partners stated. I really didnt have a choice.

I'm scared to death. The thought of RF ablation was already a terrible thought but now they want to literally cut into my heart. My EPs nurse didnt really explain as to why he suddenly thought this was my only option after pushing me for a RF ablation for the last few years.

Anyone had this done?

Is this not a pretty drastic first approach to HCM afib ablation with someone is in SR for 99% of the time? I'm currently on my max solotal dosage. When im in sinus, Im perfectly healthy aside from the rare SOB (when walking up hills, stairs etc) due to my high sotalol dose and HCM. That said. My Afib with RVR is completely unbearable when it does happen.

Nothing I can find online even hints at using such a invasive procedure for paroxysmal afib. Reports are plentiful that cite decent success with standard cath ablation procedures in patients with HCM. After all. I'm not looking for a cure. I know there isnt one. I'm just looking for less trips to the ER. I'm looking for stress relief in knowing I can travel without constantly having AFIB and a Cardioversion looming over my head.



Is my Emory EP right here? Is my only option here likely to be surgical ablation? Is it due to my 4.7cm LA size? The HCM? All the EP has told me is because of my HCM. His nurse wouldnt get technical with me. At all. They didnt even tell me this was a new procedure and wouldnt give me any real statistics on how many patients they had done this procedure on etc.

Anyway. Heres a recent echo from last Oct (no personal info etc) [imgur.com]

I have a appointment with the HCM foundation next week and have a second opinion lined up with MUSC and the Duke HCM center in mid-March (Hopefully I make it that long. I average needing a cardioversion every 6 months)

Any insight or advice would be great. Thanks guys.



Edited 1 time(s). Last edit at 01/31/2019 10:50AM by clemsonaffiber.

I don't understand why your HCM or atrial size demands a hybrid procedure and I'm skeptical that it actually does. After all, hybrid procedures are relatively new and it's not like in the past you would have been told you're out of luck.

You need a second opinion at least. A third wouldn't be a bad idea. If I were you I would locate the two best EPs outside of Emory you can find and schedule appointments with them for a consult. It's going to take a while to get in to see top EPs, so spend that time getting Emory to send all your medical records to the EPs you choose. If you can afford a trip to Austin, Dr. Andrea Natale at Texas Cardiac Arrhythmia Institute is probably the top EP in the world. He would be an optimal choice.

Good luck and let us know how it goes.

I agree with Carey. The EP that did my first 2 ablations had thrown in the towel ladn was starting to talk Hybrid with me. However I had already taken the first steps to see Dr. Natale. Best move I ever made.

Agreed, my EP had done 3 on me and was at a top teaching hospital. Ready to throw in towel when I got in with Dr. Natale and fixed in one shot and my case was a bit unique as well. Do not agree to surgery without talking to Natale first.