Convergent MAZE/EP Ablation for Atrial Fibrillation

Updated June 11, 2014
Author: J. Gagnon

Description: the Convergent combination CathLab/Operating Room ablation procedure for refractory Atrial Fibrillation

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Brief Description of Convergent Endocardial / Epicardial Hybrid Ablation

See this website link to a journal-published author Andy Kiser MD


Frequently-Asked Questions (about the Convergent Procedure)

  1.  Is this procedure done strictly in the cath lab? 
    1. It's a Hybrid procedure, 1st part performed in cardiac OR, 2nd part performed in EP lab on R8. Anesthesia management provided in OR & EP lab with anesthesia/CRNA transport between locations
  2. Are they admitted the morning of the procedure?
    1. Patient will be admitted the am of surgery.  They will need to report to admitting by 5:30a
  3. What unit are they admitted to?  Where do they recover post-op..... CTICU or Cardiac unit, R-7?
    1. Patient flow algorithm as follows:
      Same Day Admit – report to admitting by 5:30a >>> Admit to R9W/CICU (backup ACCU) >>> To Pre-op holding by 7am >>> to OR >>> to EP lab with anesthesia/CRNA transport >>> R8 holding room for 30-60” for post anesthesia management >>> to CICU >>> POD1 Blake drain removed and pt transferred to R9W >>> D/C anticipated POD3
  4. How is anticoagulation managed?
    1. EP schedulers will book outpatient TEE ~ 5-7 days prior to OR date
    2. EP APP’s & schedulers to book INR labs; manage drug taper, manage bridging
      1. Anticoagulant bridging with Lovenox required from TEE to procedure if INR <2
      2. Goal INR 1.7 – 2.2 (procedure likely to be cancelled with INR >/= 2.2)
      3. If day of admit STAT INR < 2.0 and patient hadn’t been bridged with Lovenox, repeat TEE to be performed in OR prior to procedure start
      4. Last dose of Lovenox to be midnight the night before procedure.
    3. If on Pradaxa, to be discontinued 48 hours prior to procedure
  5. Are the pts's extubated immediately post-op?
    1. Patients will be extubated in EP lab and transported to R8 holding room for 30-60” for anesthesia recovery. If patient unable to be extubated in EP lab, will be transported to CICU
  6. How long is their hospitalization?
    1. Patients can anticipate discharge on POD3
  7. When does the drainage port get removed?
    1. Blake drain will be removed by CT surgery POD1

References

AF Convergent Ablation (Powerpoint) Senior Lecture by A. Grandin MD, Grand Rounds MMC, October 2013

Convergent Maze Ablation 2011 , DAVID M. GILLIGAN, MD, FACC, CHARLES A. JOYNER, MD, FACC and GRAHAM M. BUNDY, MD, The Journal of Innovations in Cardiac Rhythm Management, October 2013