Department of Cardiothoracic Surgery Maastricht University Medical Center Maastricht, The Netherlands.
Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands.
Multimed Man Cardiothorac Surg. 2020 Nov 30;2020. doi: 10.1510/mmcts.2020.066.
Atrial fibrillation is becoming a disease that needs to be addressed with definitive long-term treatment as opposed to medical management options. Ablation or isolation of focal triggers around the pulmonary veins can eliminate arrhythmia substrates for patients with paroxysmal, lone atrial fibrillation. However, limited pulmonary vein isolation strategies do not address reentrant circuits common in persistent and longstanding persistent patients with structural heart disease and enlarged atria. The convergent procedure is a hybrid ablation treatment for atrial fibrillation. It consists of surgical ablation of the posterior left atrium through a minimally invasive closed-chest approach followed by endocardial catheter ablation. The convergent procedure was developed to treat atrial fibrillation by creating a complete and comprehensive pattern of linear lesions on the left atrial backwall under direct endoscopic visualization while avoiding chest incisions and deflation of the lungs. Endocardial ablation follows the epicardial procedure to confirm lesion integrity and supplement the epicardial procedure, which is performed in a staged fashion.
心房颤动正成为一种需要采用明确的长期治疗方法来治疗的疾病，而不是采用医疗管理方法。对阵发性、孤立性心房颤动患者，围绕肺静脉的局灶性触发灶消融或隔离可以消除心律失常的基质。然而，有限的肺静脉隔离策略并不能解决结构性心脏病和心房扩大的持续性和长期持续性患者中常见的折返环。汇聚程序是一种房颤的混合消融治疗。它包括通过微创闭式胸廓入路对左心房后侧壁进行外科消融，然后进行心内膜导管消融。汇聚程序的开发是为了通过在直接内窥镜可视化下在左心房后壁上创建一个完整和全面的线性病变模式来治疗心房颤动，同时避免开胸和肺部放气。心内膜消融紧随于心外膜手术之后，以确认病变的完整性，并补充心外膜手术，心外膜手术是分阶段进行的。
