Convergent procedure for long-standing persistent atrial fibrillation in heart failure with reduced ejection fraction

Background: Catheter ablation for atrial fibrillation in patients with heart failure with reduced ejection fraction is associated with a significant reduction in morbimortality. The convergent procedure is a valid ablation option for the treatment of long-standing persistent atrial fibrillation.

Aim: To describe the outcomes of patients with heart failure with reduced ejection fraction and long-standing persistent atrial fibrillation who underwent the convergent procedure.

Methods: We studied consecutive patients included in two French centres between 2009 and 2020. Primary endpoint was freedom from any atrial arrhythmia assessed on 24-hour Holter electrocardiogram at 3, 6 and 12 months after the procedure. Left ventricular ejection fraction was assessed on transthoracic echocardiography before and 1 year after the procedure. All patients had at least 12 months of follow-up.

Results: Forty-three patients were included (86% were men). Baseline left ventricular ejection fraction was 38±10.5% and indexed left atrial volume was 50±27mL/m². Among the study population, 34 patients (79%) were free from atrial fibrillation/tachycardia at the end of follow-up. No periprocedural death occurred. We observed two groin haematomas and four mild pericardial effusions. At 12-month follow-up, 21 patients (49%) were still on antiarrhythmic drug therapy, and a reduction in antiarrhythmic drug dosage was achieved in 10 patients (23%). The absolute median improvement in left ventricular ejection fraction was 8% at 12 months (P=0.003).

Conclusions: The convergent procedure has been shown to be effective and safe for patients with patients with heart failure with reduced ejection fraction and long-standing persistent atrial fibrillation, with significant left ventricular function improvement.