Convergent Plus is a plus for Afib patients

By JAMES DOWD

When cardiothoracic surgeon Jonathan Nitz, MD, moved to Memphis a couple years ago, he didn’t know anyone in the area, but was excited at the prospect of performing robotic thoracic surgeries and being mentored by a senior surgeon while growing as a junior attending and picking up new skills.

Nitz joined Methodist Le Bonheur Healthcare in the summer of 2024 and now performs most of his surgeries at Methodist University Hospital, while conducting many convergent procedures at Methodist Germantown Hospital.

Performing more than a dozen robotic Convergent Plus procedures since last year represents more than a technical milestone Nitz said. In his view, the procedure signals an opportunity to expand treatment options for local patients living with Atrial Fibrillation, many of whom have exhausted medications or prior interventions.

“In the Mid-South alone, there are likely more than 10,000 patients who could benefit from this procedure,” Nitz said. “My hope is that within the next few years we’ll see the volume grow substantially as referring physicians become more familiar with what it can offer.”

Although the convergent approach has existed in various forms for about two decades, Nitz believes broader adoption, particularly with robotic assistance, could significantly improve outcomes for patients with persistent or longstanding AFib. He currently averages about one per month, but his goal is to expand that number significantly.

“I’d love to see us doing one a week,” Nitz said.

Patients referred for the procedure often have already tried antiarrhythmic medications or catheter ablation. For many, the robotic convergent approach can produce rapid rhythm improvement and potentially reduce reliance on anticoagulation.

The work also carries historical resonance in Memphis. Cardiac surgeon James L. Cox, MD, performed the first surgical procedure for atrial fibrillation in the city in 1987, the same year Nitz was born.

“There’s a strong legacy of innovation in AFib surgery here,” Nitz said. “It’s exciting to contribute to the next chapter of that.”

Nitz’s path to Memphis and cardiovascular surgery began long before medical school.

Born and raised in Frankfort, Kentucky, he grew up in an academic household. His father, a neurobiologist and professor of physical therapy at the University of Kentucky, often brought his children along to conferences and academic events.

Those early experiences made the world of science and medicine feel tangible, Nitz said. But the defining moment occurred when his younger brother required open-heart surgery.

“I was 13 and it was the first time I really saw the medical profession as a potential career,” Nitz said. “I hadn’t really had a lot of exposure to surgery, but after that I saw it in a new way, and began to think of it as incredibly impressive.”

After high school, Nitz enrolled at Wheaton College, where he was initially drawn to two very different fields: human biology and archaeology. While he enjoyed both, the path toward medicine ultimately proved more compelling.

“I loved archaeology and still enjoy going arrowhead hunting with my dad when I’m back in Kentucky, but medicine attracted me because I saw it as a worthwhile endeavor to help people in what can be the darkest period of their lives,” Nitz said. “I wanted to help bring a bit of healing and light into peoples’ lives.”

Nitz subsequently conducted Alzheimer’s research at the University of Kentucky before entering medical school at the University of Louisville School of Medicine. From early in his medical training, he was drawn to surgery. That inclination was reinforced during surgical training, where he discovered a particular affinity for the operating room.

“My personality fit the idea of actively doing something with my hands rather than primarily managing medications,” Nitz said. “I’ve never been operating and felt tired. There’s so much excitement in surgery; you see things with fresh eyes every day.”

After medical school, Nitz completed a general surgery residency in Peoria, Illinois, where he was mentored by thoracic surgeon Richard Anderson, MD. During residency, Nitz gained extensive experience performing robotic procedures, eventually pursuing a dedicated robotics fellowship at Fox Chase Cancer Center in Philadelphia.

That training proved pivotal.

“Because I already had a strong robotic foundation, my attendings were comfortable giving me a lot of responsibility,” Nitz said. “That experience really shaped how I approach surgery.”

Nitz later joined Tufts Medical Center in Boston, where an unexpected rotation shifted his trajectory again.

“I expected thoracic surgery to be my career, but during my first week rotating on cardiac surgery, I completely fell in love with it,” Nitz said. “It was exciting and detail-oriented and precise and fantastic. I fought the urge to stick with what I knew and made the decision to pursue cardiac surgery, and I’ve loved it ever since.”

At Tufts, Nitz worked within one of the busiest heart transplant programs in New England, gaining experience in complex cardiac care while refining his surgical precision.

Still, he found himself particularly interested in areas where cardiac surgery intersected with other specialties, especially electrophysiology. One of those intersections is the convergent procedure used to treat persistent AFib.

The technique combines epicardial surgical ablation, often performed minimally invasively with endocardial catheter ablation performed by an electrophysiologist. The goal is to more comprehensively isolate arrhythmogenic pathways than either approach alone.

Despite its potential, Nitz notes that adoption has historically been limited.

“It’s a bit of a Catch-22,” Nitz said. “If surgeons and electrophysiologists haven’t performed the procedure, they’re less likely to refer patients for it. And without referrals, it’s difficult to build experience.”

For Nitz, the transition to robotic-assisted convergent surgery was natural.

“Because of my background in robotic surgery, the learning curve wasn’t nearly as steep,” he said.

Outside the hospital, Nitz’s life is equally full. He and his wife have six children, with five currently in school and the youngest preparing to start next year. Much of their time revolves around sports schedules, including club soccer and volleyball.

“We stay busy, but it’s a great life” he said. “It’s been fantastic getting plugged into the community and meeting so many wonderful people in Memphis and the Mid-South.”

Despite the demands of a surgical career, Nitz values the balance. After spending nearly two decades immersed in medical school, research, residency and fellowship, he says the opportunity to build a practice is deeply rewarding.

“To finally reach this point after all those years of training is incredibly satisfying,” Nitz said. “Being able to talk with patients, develop a plan, and help them get better is a privilege that I get to do every day.”