Endoscopic epicardial unipolar ablation -- a viable approach?

The treatment of persistent atrial fibrillation (PSAF) remains a challenge for electrophysiologists. Nowadays, isolation of the pulmonary veins (PVI) is a routinely applied, well proven and accepted intervention. Despite this, some patients are in refractory atrial fibrillation (AF) even after 2 or more procedures. Others are unable to receive another catheter ablation due to previous cardiac interventions. The Convergent procedure might be a good option for this type of patients. Here we report on two of these cases from our clinic: one of a female patient who underwent a TAVI procedure in our institution 3 months before the epicardial Ablation and the second old male patient with paroxysmal AF who underwent percutaneous transcatheter closure of patent foramen ovale (PFO) in 2015 after having an embolic stroke. These two cases show that the staged Convergent procedure can be performed safely and with good results even in patient who underwent previous cardiac interventions. In addition, it might be a good alternative in patients in whom a primary transcatheter ablation is impossible due to previous pathologies and interventions.