Chair Devi Nair (Jonesboro, US) led this session on recurrent atrial fibrillation post-pulmonary vein isolation (PFA) and the hybrid convergent approach, joined by Case Operator Zayd Eldadah (Washington DC, US) and panellists David DeLurgio (Atlanta, US) and Nitesh Sood (Boston, US). Zayd Eldadah presented the case of a 58-year-old male with persistent atrial fibrillation, hypertension, diabetes, and obesity. After multiple catheter ablations, including cryoballoon and radiofrequency ablation, his atrial fibrillation burden returned. Given his recurrent symptoms and failed endocardial ablations, the team opted for a hybrid convergent approach, combining epicardial and endocardial ablation. The procedure included left atrial posterior wall ablation, left atrial appendage clipping, and ligament of Marshall ablation, followed by endocardial mapping and gap closure.

The panel discussed the advantages of convergent ablation for patients with advanced atrial disease, noting its durability compared to endocardial approaches alone. They explored findings from the Converge trial, highlighting benefits for long-standing persistent atrial fibrillation. The discussion also covered patient selection, percutaneous PFA, and the role of high-density mapping. The session concluded by reinforcing the role of convergent ablation in complex atrial fibrillation cases.