“We foresee that the combination of the two approaches (i.e., surgical and percutaneous approach), in common hybrid approach, will allow a substantial reform for the definitive cure of atrial fibrillation, …, providing the highest success rates along with the best care for patients' health.”

Bisleri G, Curnis A, Bottio T, et al, The Need of a Hybrid Approach for the Treatment of Atrial Fibrillation, The Heart Surgery Forum, 2005; 8 (5): E326 - E330

In January, 2009, Dr. Andy Kiser and Dr. Mark Landers, from FirstHealth Moore Regional Hospital in Pinehurst, NC, assembled an international team of renowned Surgeons and Cardiologists in Krakow, Poland to explore new ways to treat Atrial Fibrillation. This team consisted of Dr. Rodney Horton and Dr. Andrew Hume from St. David’s Hospital in Austin, TX, Dr. David Haines from Beaumont Hospital in Detroit, MI, and Dr. Borut Gersak from University Medical Center in Ljubljana, Slovenia. They performed the first convergent procedure for Atrial Fibrillation, bringing together the expertise of Cardiac Surgeons and Electrophysiologists for the treatment of Atrial Fibrillation.

This convergent procedure allows doctors from different fields of medicine to work side-by-side to simultaneously treat Atrial Fibrillation, and now this procedure has been performed in the United States with the first patient treated at FirstHealth of the Carolinas’ Moore Regional Hospital.

Until now, Catheter Ablation and Surgery were offered as part of the many treatment options for AF. Following the ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation¹, patients in consultation with their cardiologist had few non-pharmacological choices; either endocardial ablation or some form of surgical procedure. Now, with the convergent procedure, patients can have another option that offers the best treatment from both specialties, reducing many of the less desirable aspects of both.

The Ex-Maze procedure, pioneered by Dr. Kiser, offers a beating-heart, off-bypass surgical solution to AF that has had excellent results. (See Outcomes)

Pictured (left to right) are Drs. Horton, Haines, Kiser, Bartus, and Hume performing the first convergent procedure in Krakow, Poland. Dr. Krzysztof Bartus and Prof. Jerzy Sadowski from the Jagiellonian University, Department of Cardiovascular Surgery and Transplantology in Krakow, Poland were instrumental in organizing the world’s first convergent procedure for atrial fibrillation.

In an effort to further improve on the success of the Ex-Maze procedure, Dr Kiser and a group of dedicated Cardiologists, Nurses and Physician Assistants have sought ways to reduce the less desirable aspects of the procedure, such as a right-sided thoracotomy.

Catheter Ablation has had significant improvements in recent years, but practitioners have sought ways to reduce the amount of radiation received and the time spent on the entire procedure. After the surgeons complete their part of the Ex-Maze procedure, the electrophysiologist make an electrical map of the heart to search for any residual gaps in the lesions they created. When the gaps are located, the electrophysiologist uses a special ablation catheter placed in the large vein in the leg to destroy them. They are then able to create additional lesions on the inside of the heart in locations that the surgeons are unable to reach without stopping the heart and cutting into the heart. These additional lesions further increase the ability to eliminate atrial fibrillation and prevent it from recurring.

This picture demonstrates the effectiveness of the Convergent procedure. The area in red is the posterior left atium, the site where the majority of triggers for atrial fibrillation are located. The red color indicates that this area has little, if any, residual electrical activity. This demonstrates the elimination of the electrical problems which cause atrial fibrillation.

The Convergent Ex-Maze Procedure with Electrophysiologic Studies (EPS) and intra-cardiac mapping clearly demonstrate the effectiveness of the Ex-Maze procedure. This allows for less procedure time and less fluoroscopy (radiation) exposure during catheter ablation.

For the surgeon, the Convergent Ex-Maze Procedure reduces the overall operative time, avoids right-sided thoracotomy, right lung deflation and has only three abdominal incisions; two 5 mm incisions and one only about 8 cm, in addition to the access for the catheter ablation.

For the patient, it means less pain, smaller scars and should offer a shorter hospital stay and a greater overall chance for success.

• View the American Heart Association Catheter Ablation Web Page
• Watch a video demonstrating Catheter Ablation
   
            The Convergent Procedure Lesion Pattern

¹ Fuster V, Rydén LE, Cannom DS, et al, ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). Circulation. 2006;114:e257-e354