Surgical Treatment of Atrial Fibrillation.

Atrial fibrillation (AF) is now commonly treated
at the time of valvular heart surgery or coronary artery bypass grafting. Surgical
ablation of AF, which is predicated upon the Maze procedure, includes creation
of lines of conduction block and excision of the left atrial appendage. A full bi-atrial lesion set is associated
with success in 80% to 95% of patients and virtually eliminates the risk of
late stroke. A complex but safe
operation, the classic cut-and-sew Maze procedure has been applied by
relatively few surgeons. However, recent
advances in understanding of the pathogenesis of AF and development of new
ablation technologies enable surgeons to perform pulmonary vein isolation,
create linear left and right atrial lesions, and remove the left atrial
appendage rapidly and safely. Lesions
are created under direct vision, minimizing the risk of damage to the pulmonary
veins and adjacent mediastinal structures. Recently developed instrumentation now enables thoracoscopic and keyhole
approaches, facilitating extension of epicardial AF ablation and excision of
the left atrial appendage to patients with isolated AF and no other indication
for cardiac surgery. In addition, novel
devices designed specifically for minimally invasive epicardial exclusion of
the left atrial appendage will broaden the range of treatment options for
patients with AF, possibly eliminating the need for anticoagulation in selected
patients.