Surgical ablation for atrial fibrillation: techniques, indications, and results

The aim of this review is to focus specifically on the indications, evolution of technique, and results of surgical ablation for atrial fibrillation.

With the introduction of the Cox-Maze IV procedure utilizing bipolar radiofrequency ablation and cryoablation, long-term studies have demonstrated a significant decrease in aortic cross-clamp times and major complications with a comparable rate of restoration of sinus rhythm. New hybrid approaches utilizing both catheter-based ablation and minimally invasive surgical approaches have been developed, but have not been standardized. Early studies have demonstrated reasonable success rates of hybrid procedures, with advantages that include confirmation of conduction block, decreased surgical morbidity, and possibly reduced morbidity. However, hybrid approaches have the disadvantage of significantly increased operative times.

The Cox-Maze IV is currently the gold standard for surgical treatment of atrial fibrillation. New hybrid approaches have potential advantages with promising early results, but a standard lesion set, improvement in operative times, and long-term results still need to be evaluated.