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Introduction: Atrial fibrillation increases the risk of stroke 5-fold. The efficacy of endocardial catheter ablation (CA) for drug - refractory persistent and longstanding persistent AF (PsAF) is limited and has led to the development of minimally invasive hybrid epicardial/endocardial ablation technique (hybrid Convergent) to achieve a comprehensive lesion set with durable transmural lesions. The CONVERGE IDE randomized controlled trial prospectively evaluated the effectiveness of Convergent ablation compared to CA for the treatment of PsAF. Methods: PsAF patients, >18 to Results: One hundred fifty-three patients (102 Convergent, 51 CA) with similar baseline characteristics were treated. Body mass index (mean 33.7, range 19.1- 50.1) and years since PsAF diagnosis (mean 4.4 years, range 0.5 - 26.0 years) were high; 42.5% (65/153) patients had longstanding persistent AF. In the Convergent arm, 4 major adverse events (3.9%, 4/102) were reported through the first 7 days and additional 4 events (3.9%) from days 8 - 30. The safety rates were lower than the performance goal of 12%. Rates of freedom from atrial arrythmia stratified by AAD use are included in Table1. Irrespective of the criteria, the hybrid Convergent procedure demonstrated significantly higher treatment success compared to CA (RR 1.28 - 1.67, p Conclusion: The hybrid Convergent procedure combining epicardial and endocardial ablation is safe and has superior effectiveness as compared to the endocardial catheter ablation for the treatment of PsAF, irrespective of AAD use.

A 48-year-old man with a history of idiopathic dilated cardiomyopathy, Class 3 symptoms of congestive heart failure, and left bundle-branch block with QRS duration of 164 ms was referred for revision of his implantable cardioverter-defibrillator to a biventricular pacing device. At the time of initial cardioverter-defibrillator implantation at an outside hospital, a coronary sinus (CS) lead was not placed because of …

A 60-year-old man presented to the emergency department with multiple episodes of palpitations, dyspnea, diaphoresis, and lightheadedness. One episode was associated with a syncopal event 1 week before admission. His symptoms recurred during hospitalization, at which time telemetry documented a narrow complex tachycardia at 160 bpm accompanied by hypotension. During the next 24 hours, he developed sinus tachycardia and hypotension followed by normal sinus rhythm and hypertension, which alternated in a cyclic pattern with a periodicity of ≈8 minutes (Figure …