[Surgical ablation of atrial fibrillation. Indications, techniques and results]

Catheter ablation has been the preferred choice of treatment for many patients with atrial fibrillation (AF) and advanced to a first line treatment option. However, incomplete ablation lines and varying long-term success rates remain a problem in certain subgroups, especially patients with persistent AF or large left atria. Alternative energy sources and advances in the device design have shifted the surgeons' focus on less invasive procedures. Minimally invasive performed endocardial ablation or even endoscopical ablation on the beating heart reveals success rates of 90 % freedom from atrial fibrillation at 2 years independent from the duration or type of AF. The randomized FAST-trial demonstrated superiority of endoscopic ablation compared to catheter ablation after 1 year. Given the multiple theories of the mechanism causing AF and the results that can be achieved by minimally invasive surgery, a thoroughly assessment of the individual patients is mandatory and surgery should be considered in all symptomatic patients who have failed catheter ablation or who are not good candidates for catheter ablation.