New Surgical Procedure Improves Outcomes for Most Advanced Atrial Fibrillation Cases

The convergent procedure combines cardiac surgery with radiofrequency ablation to terminate abnormal electrical pathways within the heart

Atrial fibrillation, an abnormal heart rhythm characterized by rapid and irregular beating, often starts gradually. At first, you may notice an occasional, brief feeling of a skipped or fluttering heartbeat. As it progresses, it may be accompanied by stronger heart palpitations, fainting, dizziness or shortness of breath. Many cases of arrhythmia are treatable with medications or ablation. Ablation uses radiofrequency energy to destroy the pathways to the heart that are causing the arrhythmia. However, in about 25 to 30 percent of cases, the atrial fibrillation does not respond to either medications or conventional ablation techniques. Are You a Candidate? Make an Appointment! Find out if you are a candidate for this innovative procedure. Call us to schedule an appointment with one of our cardiologists at 800.922.0000. Nebraska Medicine is the only hospital in the state to offer a new minimally invasive technique for patients with resistant atrial fibrillation called convergent. An alternative to open heart surgery, the procedure is providing up to an 85 percent success rate. Atrial fibrillation is one of the most difficult types of arrhythmia to diagnose and treat because the arrhythmia usually occurs from multiple sources in and around the heart. Nebraska Medicine’s advanced 3-D mapping provides doctors a visual map of the heart allowing them to pinpoint the exact origin of these abnormal electrical pathways. The convergent procedure combines cardiac surgery with radiofrequency ablation to terminate abnormal electrical pathways that are in hard-to-reach problem areas within the heart. Using the data gathered from 3-D mapping, the cardiac surgeon starts by making a small incision beneath the breast bone and performs an ablation on the surface of the heart. This is then followed by an internal ablation in which an electrophysiologist threads a catheter to the inside of the heart through a vessel in the groin to destroy any remaining abnormal electrical impulses. The prior alternative for the convergent procedure was a 6 to 8-hour open heart surgery.

HelenMari Merritt, DO, cardiothoracic surgeon

“This procedure is safer, has less down time and has great success rates,” says HelenMari Merritt, DO, cardiothoracic surgeon at Nebraska Medicine. Dr. Merritt has received special training to perform this surgery. “Improving outcomes for resistant atrial fibrillation cases is going to help many people,” says Dr. Merritt. “Atrial fibrillation becomes more common as we age and its prevalence is increasing. The incidence is expected to double by up to 12 million people by the year 2050.” Candidates for the procedure include those who are intolerant to medications; those whose atrial fibrillation that has not responded to medications or ablation; patients with an enlarged left atrium; and young people with atrial fibrillation. “Treatment of arrhythmias is usually required only if the arrhythmia is causing significant symptoms or if it’s putting you at risk for more serious cardiac complications,” says Dr. Delaney. “Our state-of-the-art 3-D mapping equipment combined with our experience and advanced surgical and interventional procedures allows us to diagnose and treat some of the most complex cases.”

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