Convergent Procedure

Posted by allen4501 @allen4501, Oct 12, 2021

After 2 ablations, 5 cardioversions and a final and failed attempt of using Tikosyn, my EP has asked if I would consider this new hybrid approach towards treating a-fib. It is becoming increasingly accepted at numerous hospitals with very positive results. However, Mayo has been taking a conservative approach towards using, which I understand and appreciate.

The procedure is in two phases and termed "convergent" in doing so. The first is conducted by a cardiothoracic surgeon performing a minimally invasive epicardial ablation using a radiofrequency catheter on the outside of the heart. The second is the traditional internal version conducted by the EP. Plenty of articles and videos are out there for the details on the mechanics of why this is working and how performed. From all my research, it does make sense, especially for my persistent version. Given this, and my comfort level with Mayo, I've elected to proceed. Hopefully, I will have all this completed by the end of the year and will keep you posted.

Interested in more discussions like this? Go to the Heart Rhythm Conditions group.

@allen4501, this is a great discussion to start as I don't think many members have discussed the convergent/hybrid procedure.

That is a lot of surgeries to undergo. When you say Mayo is taking a conservative approach, what all does that entail?

I read this article a while back that includes that.
https://www.mayoclinicproceedings.org/article/S0025-6196(16)30538-9/fulltext
Did the doctor say that this would be the last surgery you would need if they did this?

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Hi Amanda,

When mentioning "conservative": my understanding of how Mayo approaches any procedure or treatment is to take recognized and proven methods. These are constantly being updated or improved upon by Mayo and other institutions, and when realizing they are beneficial, they are finally adopted. While cardiac ablation is well-established, epicardial ablation has evolved from the surgical Maze procedure of making incisions on the exterior of the atrial chamber to now using a radiofrequency catheter to scar the tissue instead. This has been perfected to the stage where Mayo feels it, in combination with the traditional internal version, is a superior method to treating afib, at least for persistent patients like me.

Will it be my last? I can only hope so! But there are no guarantees, as we know these erratic electrical signals can pop up at anytime and from anywhere…

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I wish you well on your procedure. Please keep us posted on how it goes. I am sure there are others who would consider this as an option. It is difficult when trying to solve a problem like and nothing seems to work for very long. Will keep you in my thoughts and prayers.

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Hello all – an update from my "first phase" of the convergent procedure that was completed on 12/15. As the third patient undergoing in Jacksonville, I had quite an audience – the actual work was completed by their lead cardiothoracic surgeon with an EP attending and several others watching. The incision on my chest is just over an inch just below the bottom of the sternum. After completing the ablation, they also installed an AtriClip on the left atrial appendage, which I did not know even existed and learned a major area of concern where blood can gather when we are in a-fib. This required several small incisions on my left side. Both procedures required drains: one in my chest and the other on my left side…pretty interesting (but not painful) sensations when they were removed. Only had to say one night. So far, my ticker has worked perfectly! Some minor palpitations the first couple of weeks and likewise minor discomfort from the incisions, primarily on my left side, but all were expected. Phase two, which is a "normal" ablation, is in a couple of weeks to touch up the points they mapped earlier. So far so good, and will provide further updates…

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@allen4501

Hello all – an update from my "first phase" of the convergent procedure that was completed on 12/15. As the third patient undergoing in Jacksonville, I had quite an audience – the actual work was completed by their lead cardiothoracic surgeon with an EP attending and several others watching. The incision on my chest is just over an inch just below the bottom of the sternum. After completing the ablation, they also installed an AtriClip on the left atrial appendage, which I did not know even existed and learned a major area of concern where blood can gather when we are in a-fib. This required several small incisions on my left side. Both procedures required drains: one in my chest and the other on my left side…pretty interesting (but not painful) sensations when they were removed. Only had to say one night. So far, my ticker has worked perfectly! Some minor palpitations the first couple of weeks and likewise minor discomfort from the incisions, primarily on my left side, but all were expected. Phase two, which is a "normal" ablation, is in a couple of weeks to touch up the points they mapped earlier. So far so good, and will provide further updates…

Jump to this post

Were you permanently in AFIB? Is this a new procedure? I’m very interested in how you are doing.

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Hi lmurray03,

Yes, I was fighting persistent afib. Can read from the beginning of this posting back in October on how this all panned out. Plenty of articles out there to read (videos too) including the one from Mayo that Amanda notes, although you will need to scroll down to "Surgical and Hybrid Approaches to AF Management". I am pleased so far and you may want to approach your EP about the possibilities.

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Thank you so much Allen4501. When talking to my EP about the MAZE she brought up this treatment. She said they’re not doing it out here (west coast) yet. Would you mind sharing some of the resources you looked at so that I may learn more? THX again.

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Hi lizzy102 and everyone else!

When my EP suggested, I started to conduct my research. Whatever search engine you prefer, entering "convergent procedure" or adding "hybrid" beforehand, will pull up a bunch of pages with information. I centered on those from recognized hospitals like Cleveland Clinic along with entries from numerous medical publications. Some of these can get quite detailed, but if you are inclined to really dig into the procedure they are good to review and learn from. If you enter the same terms into YouTube can also see resources, but as it tends to include ones that are not applicable will need to jump around. Also, some of the terms can get mixed, as a "traditional" MAZE procedure can involve open heart surgery, which this is not, but can be included with some of the convergent entries. I am certainly no expert and do like to be educated on any type of procedure (I'm just built that way) but also add that I fully trust the professionals at Mayo 🙂

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Hey allen451, How goes it? Still feeling well? Hope so, thanks for posting this thread and for letting us know how you’re doing.

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Hi allen451. My husband is scheduled for the same procedure in Jacksonville in May and June. So glad to hear that the first segment of the procedure went well. How was your second segment of the procedure? Was Dr. Makay you cardiothoracic surgeon?

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Hi @allen451. I am considering the Convergent procedure under the advice of my EP. Your former posts have made the procedure seem like a breeze and I sure hope you are still doing well. My EP said it was a rough procedure so any information about your experience during and after your hospital stay would be greatly appreciated.

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Hi @jonna63 and welcome! I added the @ symbol for @allen451 so he could respond. I'd also like to introduce you to @lizzy102, @mozziegirl, and @lmurray03 who have discussed it.
What specifically did your EP share that made the surgery a rough one?

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