Background: The aim of this single-center retrospective study was to evaluate the long-term outcomes after the convergent procedure (CP) for treatment of AF. Methods: We analyzed the outcomes of patients that underwent CP from January 2009 until July 2020. A total of 119 patients with paroxysmal AF (23.5%), persistent AF (5.9%), or long-standing persistent AF (70.6%) that attended long-term follow-up were included. The outcomes were assessed 1 year after the CP and at long-term follow-up. At the 1-year follow-up, rhythm and AF burden were assessed for patients with an implantable loop recorder (61.2%). For others, rhythm was assessed by clinical presentation and 12-lead ECG. At long-term follow-up, patients with sinus rhythm (SR) or an unclear history were assessed with a 7-day Holter ECG monitor, and AF burden was determined. Long-term success was defined as freedom from AF/atrial flutter (AFL) with SR on a 12-lead ECG and AF/AFL burden < 1% on the 7-day Holter ECG. Results: At 1-year follow-up, 91.4% of patients had SR and 76.1% of patients had AF/AFL burden < 1%. At long-term follow-up (8.3 ± 2.8 years), 65.5% of patients had SR and 53.8% of patients had AF/AFL burden < 1% on the 7-day Holter ECG. Additional RFAs were performed in 32.8% of patients who had AF or AFL burden < 1%. At long-term follow-up, age, body mass index, and left atrial volume index were associated with an increased risk of AF recurrence. Conclusions: CP resulted in high long-term probability of SR maintenance. During long-term follow-up, additional RFAs were required to maintain SR in a substantial number of patients.

Background: Convergent epicardial and endocardial catheter ablation had been used for the treatment of persistent atrial fibrillation (PeAF). Aims: The aims of this retrospective study are to describe the pattern of arrhythmias and substrate findings in patients previously submitted to convergent ablation and showing arrhythmic recurrences (AF/AT/AFL lasting at least 30 seconds) and documented with ILR during follow up. Methods: From a cohort of 119 patient who underwent convergent ablation, we selected the 55 with arrhythmic recurrences and showing AT/AF/AFL stored in ILR memories to submit them to remap procedure. Results: We excluded 1 patient who was submitted to ablate and pace without remapping and 1 patient whose data has been lost. Among 53 patients, 69.7% experienced AF (33.9% PAF and 35.8% PeAF), 5.6% typical AFL and 30.2% AT/atypical AFL. As for the substrates found, at detailed high-density mapping we had: 66.9% with veins reconnection (regardless the gaps localization), 37.7% with low-voltage area/abnormal signals on the posterior wall, 11.3% deserving CTI ablation for typical AFL and 28.3% with different LA substrates (septal, anterior, LAA, mitral annulus and 9.4% with gaps at superior surgical line). Notably, overlaps of arrhythmic patterns and substrate were also found in the same patients. Conclusion: In our study a total of 79.1% patients had substrates related to previous convergent ablation due to gaps at pulmonary veins or superior line. The rest had an arrhythmic substrate in areas not previously ablated like posterior wall or CTI. These findings suggest that a large amount of patients submitted to convergent ablation (up to 80%) may have an arrhythmic substrate and thus potentially recurrences due to previous epi-endocardial ablation.