New Procedure for Atrial Fibrillation Patients Available at Emory Saint Joseph's Hospital

April 2015

The convergent procedure can provide new relief for patients suffering from longstanding persistent atrial fibrillation (AF), a condition that often causes irregular heartbeat, fatigue, shortness of breath, and increased risk of stroke or heart failure. The mechanics of the procedure depend upon the combined skills of a cardiothoracic surgeon and a cardiac electrophysiologist.

"Long-standing persistent AF is notoriously difficult to treat," says Dr. Michael Halkos, Emory cardiothoracic surgeon and scientific director of the Cardiothoracic Surgery Center for Clinical Research. "The standard therapies have been medication or endocardial ablation, and both have downsides that can be significant depending on the patient. This hybrid AF procedure may offer a more durable minimally-invasive option for these patients."

Dr. Halkos has teamed up with Dr. David DeLurgio, cardiologist and director of electrophysiology at the Emory Heart and Vascular Center, to offer the convergent procedure for AF patients at Emory Saint Joseph's Hospital.

The minimally invasive procedure strives to restore regular rhythm to the heart by blocking the abnormal electrical signals that cause an irregular heartbeat. It is performed under general anesthesia and takes approximately four hours. During the first phase of the procedure, Dr. Halkos makes a small incision in the abdomen to gain access to the outside of the heart through the diaphragm. He then uses epicardial ablation to create lesions on the posterior left atrial wall and around the pulmonary veins on the heart. After the surgical portion of the procedure, Dr. DeLurgio performs a standard endocardial ablation where he can use mapping systems to check the surgical ablation lines and complete the lesion set endocardially.

"The convergent procedure combines the best of what the electrophysiologist and the surgeon have to offer," says Dr. Halkos. "The surgeon ablates the back of the left atrium, which is typically the most challenging part of the operation for the electrophysiologist. The electrophysiologist can use advanced mapping techniques to ensure successful ablation, and reliably ablate the pulmonary veins and other specific lesion sets. Although short-term results are encouraging, longer-term follow-up is needed."

To begin measuring the overall effectiveness of the procedure, Drs. Halkos and DeLurgio will be participating in a randomized clinical trial comparing hybrid AF ablation to conventional endocardial ablation.