Surgery for atrial fibrillation: a worldwide review

Maze procedure is highly effective in converting atrial fibrillation (AF) back to sinus rhythm and significantly prevents thromboembolism postoperatively. However, the procedure has not been widely performed by many surgeons, because of the technical demand and potential risk of complications of the procedure. During the past several years, the surgical strategy for AF has evolved dramatically and significantly. The evolution can be classified into two strategies: simplification of the lesion set and development of ablation devices. Isolation of the pulmonary veins with or without left atrial incisions has been shown to cure AF in selected patients. During the past decade, a number of ablation devices have been developed to replace the cut-and-sew lesions of the maze procedure and lessen the invasiveness of the procedure. The challenge in AF surgery is in the development and establishment of an off-pump thoracoscopic procedure in the patients with isolated AF. In addition to the development of ablation devices, intraoperative electrophysiological assessment of the triggers and substrates of AF for a step-by-step tailored approach and verification of conduction block over the ablation line should be established to accomplish a high success rate for AF.