Written by Lisa Buffington
When David Smith—a devoted son, husband, father of three and grandfather
of six—was diagnosed with atrial fibrillation (AF) during a routine
checkup with his primary care provider, he knew he needed a treatment
that could keep up with his busy lifestyle.
Torrance Memorial Lundquist Lurie Cardiovascular Institute cardiothoracic surgeon
John Stoneburner, MD, and cardiac electrophysiologist
Sang Yong Ji, MD, had just the solution Smith, age 65, was looking for: a hybrid procedure
called convergent ablation. Best of all, this lifelong Torrance resident
could access this promising treatment without leaving the South Bay.
Expert Care for a Challenging Condition
When Smith’s physician referred him to Dr. Stoneburner and Dr. Ji,
Smith learned AF is an irregular heart rhythm caused by abnormal electrical
activity in the atrium — or the heart's upper chamber. AF affects
6 million Americans and can cause serious complications.
“AF is harmful to the heart and the body,” says Dr. Stoneburner.
“In patients with AF, heart function decreases, mortality increases
and the risk of stroke increases five-fold. Patients with AF also are
more likely to experience a severe stroke.”
Smith also learned he has persistent AF, meaning the problem has been continuously
occurring. Persistent AF affects approximately 70% of people who have
been diagnosed with AF and is more challenging to treat than paroxysmal
AF—the term for AF that comes and goes—using conventional
Conventional ablation procedures burn or freeze areas inside the heart
using a thin, flexible tube called a catheter inserted into a vein through
a small incision on the groin. Ablation creates scar tissue that breaks
up the electrical signals causing irregular heartbeats.
Current success rates of AF ablation procedures are compared based on the
percentage of patients who remain AF-free during the first year after
the procedure. “The success rate up to a year for a single catheter-based
ablation procedure can be up to 80% for paroxysmal AF, compared to 40%
to 60% for patients with persistent AF—and even lower for patients
after a year,” says Dr. Ji.
Ablation performed during open-heart surgery has very high success rates.
However, open-heart surgery is not typically performed for patients experiencing
AF without any other cardiac abnormalities because the procedure is very
invasive and comes with higher surgical risks and a longer recovery time.
Medications for AF may be helpful for some people, but they may not work
“These problems have led physician-scientists to come up with better
ways of treating people with persistent AF,” says Dr. Ji.
An Advanced Procedure with Outstanding Results
One of the most promising ways of treating persistent AF is by performing
a two-stage hybrid ablation procedure called convergent, which combines
minimally-invasive cardiac surgery with conventional AF ablation.
Torrance Memorial is the only hospital in the South Bay to offer the convergent
procedure, allowing patients like Smith to receive treatment for persistent
AF close to home. As one of the first hospitals on the West Coast to offer
the convergent procedure—in 2017—the multidisciplinary team
at the Lundquist Lurie Cardiovascular Institute is among the most experienced
in the region, contributing to the team’s outstanding outcomes.
“So far, the experience in our center has been quite promising, surpassing
the 80% success rate that we usually cite [for the convergent procedure],”
says Dr. Ji.
“Dr. Stoneburner and Dr. Ji explained that if I had [the convergent
procedure], I had up to an 80% chance of treatment success for the first
year after the procedure,” says Smith. “If I had [conventional
ablation], there was a lower chance of long-term success, and I may have
to go back and do it again.”
During the first stage of Smith’s procedure on August 20, 2020, Dr.
Stoneburner made a small incision in his lower chest and inserted a catheter
and a camera that provided a view of the surgical area. Dr. Stoneburner
then guided the catheter to the outside of the back of the heart and used
radiofrequency energy to create scar tissue that neutralized irregular
The doctor also inserted a device called AtriClip® to close off Smith’s
left atrial appendage (LAA), a small sac off the heart's left atrium
where blood clots commonly form. Blood clots can be a side effect of AF,
significantly increasing stroke risk. AtriClip reduces this risk by preventing
blood clots from leaving the LAA and traveling to the brain.
“I was in the hospital for six days, and I only had two small incisions
on the left side of my rib cage, and one under my sternum,” says
Smith. “Other than a little soreness around the incisions, I had
On September 17, 2020, after allowing four weeks for the inflammation from
the first stage of the procedure to resolve, Smith returned for a same-day
conventional ablation procedure performed by Dr. Ji in Torrance Memorial’s
state-of-the-art cardiac catheterization lab. During the second stage
of the procedure, Dr. Ji inserted a catheter into one of Smith’s
veins through a small incision in his groin. After guiding the catheter
to the proper location, Dr. Ji tested the electrical signals in his heart.
“During the second stage of the procedure, we can use ablation to
touch up any areas that may not have been reachable during the first stage,”
says Dr. Stoneburner.
After Dr. Ji confirmed the success of the first stage of the procedure
and ablated a few small areas inside Smith’s heart. His heart started
beating normally. During the second stage of ablation, Dr. Ji also found
out Smith had another type of arrhythmia called atrial flutter located
in the right atrium of his heart. Dr. Ji successfully ablated the area
and later told him the success rate for the atrial flutter ablation was
up to 95%.
“Dr. Ji told me in the recovery room that he has never seen anything
like it,” says Smith. “Normally, the electrophysiologist has
to wait a few minutes to check the heart’s response, but I was fortunate
it happened right away.”
Keeping the Beat
Since September 2020, Smith’s heart has kept the beat. “My
heart’s like a metronome, and I can’t say enough good things
about the procedure. I’m back to all my normal activities.”
That means caring for his 87-year-old mother, taking daily walks with his
wife and helping his son replace the roof on his house. And Smith wants
other South Bay residents to know about this innovative treatment for AF.
I was born and raised in Torrance, and I have never been in the hospital
before, so I was glad to be able to have this treatment without having
to travel too far,” he says. “I would tell others not to hesitate
to have this procedure at Torrance Memorial if their physician recommends
it. If telling my story can help someone else, it’s the least I