Surgical treatment of atrial fibrillation

While most patients with atrial fibrillation (AF) are treated with medical therapy or catheter ablation, there are many instances in which surgical treatment is indicated. Surgical techniques have evolved during the past 20 years, and currently, most are performed with radiofrequency or cryoablation as an additive part to cardiac surgery for other pathology. Ablation of AF is most commonly performed during mitral valve surgery, but there are several other instances in which it offers potential benefit, including during repair of congenital heart disease, for tachycardia-induced cardiomyopathy, and during septal myectomy for obstructive hypertrophic cardiomyopathy. New instruments have been developed to facilitate and simplify AF ablation, however, equivalency to the classic cut and sew Maze procedure has not been demonstrated. In addition, new lesion sets have been proposed, but, future comparative studies are necessary to elucidate the optimal approach when ablation of AF is considered.