Convergent hybrid ablation procedure: A novel treatment for persistent AFib

Convergent hybrid ablation was approved for patients with longstanding persistent AFib by the U.S. Food and Drug Administration (FDA) in 2021. Your cardiology team will help determine whether you meet the criteria for this new two-stage treatment, which may be more effective than other methods for treating resistant AFib.

UW Health offers convergent hybrid ablation through a collaboration between cardiovascular surgeons and electrophysiologists — cardiologists who specialize in treating the heart’s electrical system.

Who is eligible?

Most AFib patients do not need convergent hybrid ablation. However if your symptoms persist for at least one year, even after having a conventional ablation, this new approach may help reduce your AFib symptoms. Patients who cannot take blood thinners or have undergone prior open-heart surgery are not eligible for convergent hybrid ablation.

Phase one – ablation outside of the heart

Convergent hybrid ablation is performed in two stages and both are minimally-invasive procedures. In the first stage, a cardiovascular surgeon makes small incisions under the breastbone and in the chest wall before delivering heat energy to the heart's outside back wall to create scars in the electrical tissue. Because electrical activity cannot pass through scars, this procedure redirects the electrical activity around the area that is causing AFib. Although performed by a surgeon in the operating room this procedure is not open-heart surgery.

Phase two – ablating inside the heart

Phase two is performed approximately six weeks following the surgical ablation and is similar to a conventional catheter ablation. An electrophysiologist creates scarring along the AFib-source area inside the heart. This is done by inserting a thin flexible tube (catheter) into a vein in the groin and-or neck and moving it forward until it reaches the heart. Using fluoroscopy (or video X-ray) and-or ultrasound, the physician delivers cold or heat energy to reinforce or build upon the scarring created during phase one.

What to expect

Phase one is performed under general anesthesia. It typically lasts three to four hours, and patients typically spend one or two days in the hospital before completing recovery at home. There are no major at-home restrictions, aside from not lifting weight greater than 10 pounds for two weeks.

Phase two is an outpatient procedure that occurs in the cardiac catheterization lab and typically lasts two hours. It is performed under general anesthesia or deep sedation. Most patients go home the same day. The only at-home restriction is to avoid lifting weight greater than 10 pounds for five to seven days.

Some patients may need blood work and/or heart imaging (MRI or CT scan) done before having the procedure. Also, patients need to take a blood thinner for at least one month before and three months following the procedure, although your team may recommend blood thinners long term.

Convergent hybrid ablation is another way in which UW Health cardiothoracic surgery and electrophysiology teams collaborate to improve the quality of life for qualifying AFib patients. This procedure is currently available at academic medical centers with longstanding reputations for outstanding heart health care, such as UW Health.