Off-pump epicardial compartmentalization for ablation of atrial fibrillation

The Cox-Maze-III procedure still remains the gold standard in surgical treatment of atrial fibrillation. The major hazard of atrial fibrillation is thromboembolic event to the brain. Left atrial appendage (LAA) represents the source of thrombus and subsequent embolism although LAA obliteration is a key point to prevent thrombogenesis. We describe a simplified off-pump compartmentalization procedure using epicardial radiofrequency ablation of the left atrium and LAA stapling on the beating heart without cardiopulmonary bypass.