Hybrid Procedures

VATS MAZE

Video-assisted thoracoscopic surgery maze procedure (VATS MAZE) and Convergent approach are examples of cardiothoracic hybrid procedures that can be used to treat persistent atrial fibrillation.

Convergent Procedure

The convergent procedure is a hybrid procedure where the cardiothoracic surgeon and the electrophysiologist come together and perform two procedures in one setting, in efforts to decrease the atrial fibrillation burden and/or restore the heart back to normal sinus rhythm. In this procedure, a subxiphoid approach is used to perform pulmonary vein isolation ablation, and the posterior atrial cavity is ablated as well.

Convergent Plus Procedure

The convergent plus is also a hybrid procedure but involves ablating more, to get better chances of getting rid of atrial fibrillation, or decreasing atrial fibrillation burden. It is a modified maze with the ablation of the posterior wall of the left atrial cavity, reached by a subxiphoid approach. A thoracoscopic approach is also used to isolate the left superior and inferior pulmonary veins, with associated left atrial cavity roof and floor line ablation, and right pulmonary vein isolation. This is followed by a transseptal catheterization with internal electro-anatomical mapping of the left atrial cavity and pulmonary veins, and with testing for entrance and exit blocks, followed by cryoablation or laser ablation of portions which have not been blocked. Usually, the left atrial appendage exclusion procedure is also done, to close off the left atrial appendage, so that blood clots can no longer form in there.