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Normally, your heartbeat is controlled by electrical signals that start in a special area of the heart called the Sinoatrial node (SA node). These signals travel through dedicated pathways across the heart, coordinating each heartbeat and allowing it to pump blood in a steady, regular rhythm. When this electrical system is disrupted, the heart may beat irregularly. These abnormal rhythms are known as Arrhythmia. The most common type of arrhythmia is Atrial fibrillation (AF). In this condition, many small, disorganised electrical signals develop in the upper chambers of the heart (the atria). This causes the heart to beat irregularly and often faster than normal, rather than maintaining a steady rhythm.
Atrial fibrillation is very common, affecting around 0.4% of the general population and up to 5% of people over the age of 65. As the population ages, it is expected to become even more widespread in the coming years. For many patients, AF can cause symptoms such as tiredness, breathlessness, dizziness, and palpitations, which can significantly affect quality of life. In addition to these symptoms, atrial fibrillation increases the risk of serious health problems, including hospitalisation, heart failure, stroke, and even death. This is why recognising the condition and seeking appropriate medical care is so important.
In many people, Atrial fibrillation can be effectively controlled with medication, allowing them to live a normal life with few or no symptoms. Alongside medical treatment, there are several lifestyle and health factors that can be improved to help manage the condition. These include controlling blood pressure, maintaining a healthy weight, reducing alcohol intake, and treating any underlying medical conditions. Focusing on these modifiable risk factors is an important first step in managing atrial fibrillation. However, in some cases, atrial fibrillation can be difficult to control or may not respond well to medication. When this happens, symptoms can become more severe. A fast and irregular heartbeat may reduce how effectively the heart pumps blood, leading to low blood pressure, dizziness, or breathlessness. There is also an increased risk of blood clots forming in the heart, which can travel to the brain and cause a stroke.
When symptoms remain troublesome despite medication, more advanced treatments may be considered. One option is Electrical cardioversion, where controlled electrical energy is delivered through pads on the chest to restore a normal heart rhythm. Another common treatment is Catheter ablation, where a specialist uses fine instruments to target and destroy the abnormal electrical pathways causing the arrhythmia. This is performed in a specialised cardiac catheterisation laboratory. In some patients, particularly those with long-standing atrial fibrillation, more than one ablation procedure may be needed to achieve a lasting normal rhythm.
If these treatments are not successful, or if a patient is already undergoing heart surgery for another condition (such as bypass surgery or valve repair) surgical treatment may be recommended. This is known as Maze surgery, where carefully placed lines of scar tissue are created to block abnormal electrical signals and restore a regular rhythm. In selected patients, a Surgical cardioablation may be performed as a standalone procedure. Another advanced option is Hybrid cardioablation, which combines both surgical and catheter-based techniques to improve success rates in more complex cases.
All of these procedures aim to improve quality of life by reducing symptoms and helping restore a more normal heart rhythm. Your specialist team will guide you through the options and recommend the most appropriate treatment based on your individual condition.
Heart rhythm monitoring wearable devices such as the Apple Watch, Samsung Galaxy Watch, Withings ScanWatch, Fitbit Sense 2, and AliveCor KardiaMobile are medically certified wearable devices that can help monitor your heart rhythm throughout the day and night. Using built-in sensors and ECG technology, these devices can detect irregular heartbeats, fast or slow heart rates, and rhythm abnormalities such as atrial fibrillation (AF). Modern certified wearables have been shown to be highly accurate in detecting atrial fibrillation, with many studies demonstrating accuracy rates above 90% under appropriate conditions. For many people, wearable technology provides reassurance and may help identify symptoms such as palpitations, dizziness, or episodes of feeling unwell that can otherwise be difficult to capture during a routine clinic visit. The information recorded can also be shared with your doctor to support further assessment and guide treatment if needed. While wearable devices are not a replacement for medical tests or specialist review, they are becoming an increasingly valuable tool in helping patients take a more active role in monitoring and protecting their heart health.
The Maze surgery is a well-established surgical treatment for Atrial fibrillation. During this procedure, the surgeon creates a carefully planned pattern—often described as a “maze”—within the heart tissue. This helps guide electrical signals along the correct pathways, allowing the heart to return to a more normal, regular rhythm. For patients who have occasional atrial fibrillation or symptoms that have been present for a shorter period (typically up to around 12 months), a more limited procedure focused on the left upper chamber of the heart (left atrium) may be recommended. However, if atrial fibrillation has been present for a longer time, a more comprehensive approach is often needed. This may include isolating the pulmonary veins (a common source of abnormal signals) along with creating additional lines of treatment to interrupt faulty electrical circuits.
To perform the procedure, surgeons use specialised equipment known as a cardio-ablator, which creates controlled, shallow lines (lesions) on the surface of the heart. These lines act like barriers (similar to a “Great Wall”) blocking abnormal electrical signals while allowing normal pathways to function properly. The number and pattern of these lines depend on the type and duration of atrial fibrillation. In many cases, this type of surgical ablation can be performed using minimally invasive techniques, meaning the heart does not always need to be opened. However, a more traditional approach may be required if more extensive treatment is needed or if the patient is undergoing another heart procedure, such as valve surgery at the same time.
When surgical ablation is performed alongside another heart operation (known as concomitant ablation), it is generally associated with only a very small additional risk compared to the main procedure itself. Importantly, the potential benefits (such as improved recovery, better long-term heart rhythm control, and enhanced quality of life) often outweigh this small increase in risk many times over. In many patients, it may also contribute to improved long-term outcomes, including reduced complications related to atrial fibrillation.
Surgical ablation can be performed as a stand alone surgical ablation procedure, but it is often carried out alongside other heart operations to maximise overall benefit. The goal is to reduce or eliminate symptoms, restore a normal heart rhythm, and improve both quality of life and long-term heart health. Your surgical team will carefully assess your condition and recommend the most appropriate approach tailored to your needs.
The Convergent (Hybrid) Approach is an advanced treatment for atrial fibrillation (AF) that combines two established techniques: catheter ablation, performed through blood vessels, and a minimally invasive surgical procedure carried out through a small incision without opening the chest. By integrating these approaches, doctors can treat AF more effectively, particularly in patients with more complex or long-standing disease.
This treatment is typically offered to patients with long-standing atrial fibrillation, usually lasting more than one year, especially when other treatments have not been successful. It may be recommended for individuals who have previously undergone unsuccessful catheter ablation, those with heart failure, patients with an enlarged left atrium (>40ml/m2), or those who are affected by obesity. Your doctor will assess your individual condition to determine whether this treatment is suitable for you.
The Convergent procedure is designed for patients whose AF is more difficult to manage. Clinical experience has shown that it can be more effective than catheter ablation alone in treating persistent and long-standing persistent atrial fibrillation, offering improved outcomes for many patients. The main goal of the Convergent approach is to help patients maintain a normal heart rhythm (sinus rhythm) over the long term. Achieving this can reduce the need for repeat procedures, lower the likelihood of requiring electrical cardioversions, and decrease dependence on antiarrhythmic medications. This approach uses a multidisciplinary team of cardiac surgeons and heart rhythm specialists who work together to deliver treatment. By applying well-established ablation techniques in a less invasive, “closed chest” manner, the Convergent procedure aims to improve effectiveness while also supporting a smoother recovery.
The First Stage – Surgical Part (Keyhole Surgery)
Before the procedure, you will be given a general anaesthetic so that you are asleep and comfortable throughout. You will lie on your back while the medical team closely monitors you at all times. As with any procedure, the outcome can vary depending on factors such as your age, overall health, and activity level. Your doctor will carefully assess whether you are a suitable candidate for the Convergent procedure.
During the procedure, the surgeon makes a small incision (about 2 cm) just below the breastbone or in the upper abdomen. Through this opening, they gain access to the pericardium, the protective sac around the heart. A small tube (cannula) is then inserted to guide a specialised device (EPi-Sense) to the back surface of the heart. This device delivers controlled radiofrequency energy to create precise areas of scar tissue. These scars help block the abnormal electrical signals that cause atrial fibrillation.
After the procedure, you will be closely monitored while you recover. Your doctor will advise how long you need to stay in hospital and will discuss any medications you may need, including those for heart rhythm control or pain relief. Usually you can go home the same night or the day after the procedure. Before you go home, a follow-up appointment will be arranged, usually around six weeks after the procedure. You will also be given information about the second stage of the treatment, which is part of the overall Convergent approach.
After the first stage of the procedure, your heart rhythm may return to normal (sinus rhythm), either temporarily or permanently. However, even if this happens, it is still very important that you go ahead with the second stage of treatment. This step ensures that the procedure is fully completed and helps make the results of the hybrid approach more durable and long-lasting.
The Second Stage – Percutaneous Completion Ablation
After 6–8 weeks from your initial procedure with the EPi-Sense device, you will return for the second stage of treatment. This involves a detailed heart rhythm study, carried out by a specialist heart doctor (electrophysiologist) in a dedicated electrophysiology laboratory. Even if your heart rhythm has returned to normal (sinus rhythm) after the first stage, it is important that you still undergo this second procedure. This step helps ensure that the treatment is complete and that the results of the hybrid approach are durable and long-lasting.
During this procedure, the electrophysiologist will insert thin, flexible wires called catheters into a blood vessel in your groin and gently guide them up to your heart. These catheters allow the team to carefully map the electrical activity inside your heart. If any areas are still causing abnormal signals, additional targeted treatment (ablation) can be performed to complete the procedure.
Afterwards, you will be monitored as you recover. Your doctor will advise how long you need to stay in hospital and will discuss any medications you may need, including those for heart rhythm control or pain relief. This is a day case procedure., and you most probably will go home on the same day. A follow-up appointment will be arranged in the outpatient clinic, usually about three months after this second procedure, to check your progress.
The Convergent Procedure offers new hope for people living with persistent atrial fibrillation. By combining two complementary treatment approaches, it provides one of the highest chances of restoring a normal heart rhythm (sinus rhythm) and keeping it stable over the long term. For many patients, this means fewer symptoms such as palpitations, breathlessness, tiredness, and reduced exercise capacity. Maintaining a normal heart rhythm can make everyday activities easier, improve energy levels, and help people regain confidence in their health and wellbeing. With a greater likelihood of lasting results and a reduced need for additional procedures, the Convergent Procedure can significantly improve quality of life and help patients return to the activities they enjoy most.
The Left atrial appendage (LAA) is a small pouch within the upper left chamber of the heart. In patients with atrial fibrillation, blood can collect and become stagnant in this area instead of flowing normally. When blood remains still, it can form clots, and if a clot breaks loose, it can travel to the brain and cause a stroke. The left atrial appendage is recognised as the main source of clot formation in atrial fibrillation. In fact, around 90% of stroke-causing clots in patients with non-valvular AF originate from this area, making it a key focus in preventing serious complications.
Stroke is the most serious complication of atrial fibrillation. It is estimated that AF is responsible for around 20% of all strokes, with the risk increasing significantly with age. In people over the age of 65, the likelihood of stroke can be as high as 20%. Importantly, strokes related to atrial fibrillation are often more severe than other types, as they are typically caused by larger clots, leading to more significant brain injury, disability, or death. Stroke remains one of the leading causes of death in Western countries.
For patients with atrial fibrillation who are undergoing heart surgery, there is an opportunity to reduce this risk. Closing the left atrial appendage during surgery (a procedure known as Left atrial appendage occlusion or excision) has been shown to lower the risk of stroke and other clot-related complications. When this is performed alongside surgical cardioablation, it not only helps restore a more normal heart rhythm but also lowers further the likelihood of blood clots forming inside the left atrium. As a result, some patients may be able to reduce or avoid long-term use of blood-thinning medications (anticoagulants), depending on their individual risk profile.
Over the years, several techniques have been developed to remove or close off the left atrial appendage. Traditionally, this could be done by surgically cutting and sealing the appendage using specialised stapling devices. While effective, newer techniques have been designed to improve safety and reliability. One of the most widely used and safest modern options is the AtriClip. This device is placed around the base of the appendage to permanently close it off from the rest of the heart. It has been shown to achieve very high success rates, with excellent safety outcomes and no significant device-related complications reported in most studies. The atraumatic closure of the left atrial appendage using the AtriClip is particularly beneficial for patients who are unable to take blood-thinning medications due to side effects or other medical reasons. By safely sealing off the main area where blood clots tend to form in atrial fibrillation, this approach helps reduce the risk of stroke. The AtriClip works by gently closing the appendage from the outside of the heart, allowing natural healing to occur without leaving any foreign material inside the bloodstream, such as stents, staples, or sutures. This makes it a reliable and effective alternative for stroke prevention, while also supporting an improved quality of life for many patients.
The AtriClip comes in a range of sizes, allowing it to be tailored to each patient’s individual anatomy. It can be applied during other heart operations or performed as a minimally invasive, standalone procedure. In some cases, it may even be suitable as a day-case treatment.
