Treatment of atrial fibrillation

In recent years, the interest towards non-pharmacological treatment of atrial fibrillation has dramatically increased. Less invasive left atrial approaches are today widely adopted in cardiac surgery, mainly for concomitant treatment of secondary AF. Epicardial ablation, especially with the latest generation devices, has rendered most of the ablation feasible off pump, on the beating heart, thus opening the way to minimally invasive and thoracoscopic developments. In the meantime, percutaneous procedures have been greatly refined. Complete left lesion sets similar to those performed surgically are today feasible with good clinical results. Presently, even if percutaneous approaches seem more suitable as a first-line treatment for lone AF, surgical ablation is proving useful in a growing number of patients. It is possible to envision a stronger role of surgery in patients with lone AF refractory to percutaneous ablation or in those with a higher thromboembolic risk.