Convergent Procedure: Experience at UNC-CH

In a new article, authors Ayotunde M. Bamimore, MD, J. Paul Mounsey, BM, BCh, PhD, and Andy C. Kiser, MD from the University of North Carolina at Chapel Hill discuss their experience with the collaborative convergent epicardial and endocardial RF ablation for atrial fibrillation (AF). They present a case of a 63-year-old man with a five-year history of paroxysmal AF that transitioned to persistent AF in the six months preceding consultation, resulting in worsening fatigue and shortness of breath. The authors recommended a convergent epicardial and endocardial AF ablation given the anticipated low likelihood of success with conventional endocardial ablation. Six weeks later, the patient has marked improvement in energy and is still in sinus rhythm.

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The authors write that this collaborative strategy of cardiac surgery and EP working together holds promise for the future. They note that with the convergent strategy, the addition of endocardial lesion sets improves on the shortcomings of “epicardial-only” minimally invasive procedures. They believe the convergent AF ablation strategy is an effective method of treating longstanding persistent atrial fibrillation in patients with structural heart disease.


Have you discovered EP Lab Live yet?

Registration is free to view these presentations! See what’s available at
Arctic Front Advance™ Cardiac CryoAblation Catheter: Simply Cool
Arctic Front Advance™ Cardiac CryoAblation Catheter is the second generation of the world’s first cryoballoon indicated for the treatment of paroxysmal atrial fibrillation (PAF). Building upon the proven safety and efficacy of the original Arctic Front® Cryoballoon, this technology provides an efficient approach to pulmonary vein isolation (PVI). Arctic Front Advance features the new EvenCool™ Cryo Technology, which optimizes the delivery of coolant inside the balloon. By allowing more flexibility in balloon positioning to ablate the PVs, this new product enhancement is designed to improve physicians’ ability to treat patients with a wide variety of vein anatomies with less effort.

Innovations in 3D Rotational Imaging
This educational video with with Vivek Reddy, MD demonstrates the benefits of Philips advanced technology in the EP lab. Specific attention is devoted to EP navigator and the latest innovation in 3D rotational scanning technology—a reduced angular scanning range.

Initial Experiences with the ThermoCool® SF Catheter Webinar
Please join your colleagues as they share their experiences, clinical considerations, and outcomes while using this new generation of porous-tip irrigated catheters in atrial fibrillation ablation.

Benefits of Advanced Technology in the EP Lab
This recorded case with Rishi Anand, MD highlights the benefits of using Philips advanced technology in the EP lab. Specific attention is devoted to EP navigator with 3DATG (3D rotational scan imaging of the left atrium), overlay of the 3D anatomy on fluoro and export of the 3D anatomy to Biosense Webster’s Carto 3 product.

Hemodynamic Support During Complex VT Ablation: Use of Impella 2.5
Featured presentation with Larry A. Chinitz, MD, Professor of Medicine and Cardiac Electrophysiology, New York University Langone Center.

Maximizing Integration with EP Navigator’s Real-Time 3D Image Acquired in Lab and Biosense Webster’s Carto 3
Specific attention is devoted to the EP navigator 3D ATG’s imaging of the left atrium and the benefits of using technology to assess patient anatomy. The presenters also demonstrate how this image imports and interfaces with Biosense Webster’s Carto 3 product. Also to be discussed: how to acquire the 3D ATG rotational scan, and the practical workflow and benefits of subsequently using these images in Carto 3.

Philips Advanced Tools in Practice — Recorded Live Case with Pierre Jaïs MD in Bordeaux-Pessac, France
This complex atrial fibrillation/flutter case from the Hôpital Cardiologique Haut-Lévêque in Bordeaux-Pessac, France was performed in April 2010. Professor Pierre Jaïs takes the viewer through the clinical history of the patient and the treatment strategy followed in Bordeaux. In 15 minutes, the key moments from the 5.5-hour procedure are highlighted and the treatment progress described.

To see more, check out Cath Lab Live and Vascular Live!

Most Read Online Articles

Have you been to EP Lab Digest®’s website recently? Interested in what your EP colleagues are reading? Currently the most popular articles on our website are as follows:

• A New Option Against Radiation Exposure: Dr. Xiaoke Liu Discusses His Use of the ZeroGravity Radiation Protection System
• Changes Coming for 2013 CPT Codes
Intracardiac Echocardiography 101: The Beginner’s Guide to ICE Imaging and Cardiac Structure Recognition
• Gender Matters: Why Afib Is More Fatal for Women
• The Familial Arrhythmia Network of Scotland
• Keeping Meaningful Use from Becoming Meaningless Abuse: A Cardiology/ Electrophysiology Perspective
• Impact of Cardiac Resynchronization Therapy on the Management of Systolic Heart Failure
• EP 101: Ventricular Tachycardia

Let us know what have been your favorite articles! Thanks for reading!

Experience with the LARIAT Device

In a new article in the April 2013 issue of EP Lab Digest®, authors Suneet Mittal, MD and colleagues discuss their use of the LARIAT® Suture Delivery Device (SentreHEART) at The Valley Hospital. They write that “This system was developed to achieve the following technical goals: 1) complete and immediate anatomic closure; 2) no requirement for short-term post-procedure anticoagulation to allow for endothelialization or other tissue growth over an implanted occlusion device; 3) absence of foreign bodies or implants left in the patient; and 4) a non-surgical, minimally invasive procedure.” The authors conclude that the LARIAT device provides an option for LAA closure in patients who are unable to use chronic anticoagulation for atrial fibrillation.

In our February 2013 issue, Grant R. Simons, MD, FACC, FHRS from Englewood Hospital and Medical Center also described his initial experience using the LARIAT device for intra-pericardial ligation of the LAA in two patients with multiple risk factors for stroke and absolute contraindications to systemic anticoagulation. He noted that “for high-risk AF patients with absolute contraindications to anticoagulation, this procedure offers an option worth considering, and we anticipate an increasing volume of LARIAT cases.”

Is your EP program using the LARIAT device? Let us know what your case experience has been like!