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Convergent Ablation at Monument Health Heart and Vascular Institute

Aug 23, 2021 07:00AM ● By Med Magazine

By Alex Strauss

Eight to ten million Americans suffer from atrial fibrillation, the most common type of arrhythmia. Afib can cause symptoms ranging from shortness of breath to fatigue to palpitations and even stroke. People with long-standing Afib may develop tachycardia-induced cardiomyopathy. 

"Many are well managed on medical therapy. But there are a large number of patients who don't do well on the blood thinners," says Charan Mungara, MD, a Cardiovascular Surgeon at Monument Health Heart and Vascular Institute. "These are the patients that we start thinking of other interventions."

Endocardial ablation, which ablates the portion of the back wall of the heart from inside using a catheter, is one treatment option. But some patients with more complex or intermittent Afib - especially those for whom the condition has lasted longer than six months - get better results with a multidisciplinary intervention called convergent ablation. 

"It's called 'convergent' because the surgical team and EP colleagues collaborate to provide the best thing for these patients," says Dr. Mungara.

The convergent ablation procedure is a hybrid approach, involving both a minimally-invasive epicardial procedure and endocardial ablation. 

In the first stage, Dr. Mungara makes a small incision below the breast bone through which a cannula and camera are inserted and positioned at the posterior left atrium. Under direct visualization, he performs RF ablation on the back wall of the heart. Afterwards, Dr. Mungara uses a clip to seal off the left atrial appendage, reducing the risk of stroke from blood clots formed there to near zero.

The second stage of convergent ablation happens four to six weeks later, after these areas have begun to heal. At this point, an electrophysiologist threads a catheter from the groin to the inside of the heart and "touches up" any areas that were unreachable during the surgical portion of the procedure.

"We are working from outside to inside and our electrophysiology colleagues are working from the inside to the outside, so we meet in the middle," says Dr Mungara. More than 70 percent of patients are cured of their Afib with the convergent approach. This summer, the FDA approved AtriCure's EPi-Sense System for convergent blation as the standard of care for long-standing Afib. 

Convergent ablation has been available at Monument since last October and Dr. Mungara expects to complete 60 to 70 cases by year's end, making Monument's program one of the busiest convergent programs in the country. 

"This is because we have really collaborative physicians who understand that this is the best approach for our patients," says Dr. Mungara."You don't see this kind of collaboration in a lot of other programs, where everyone is in their own silos."