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Updated: Jun 27, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Treating Atrial Fibrillation is No Maze: A Reminder to Heart Teams for Concomitant Surgical Ablation for Atrial
Raghav Chandra1, Jason Guo2, Jewon Sohn2
1Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Insights
Concomitant surgical ablation (CSA) effectively treats atrial fibrillation (AF) during heart surgery, yet its adoption remains low. This review highlights CSA
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Atrial fibrillation (AF) is the most common cardiac arrhythmia.
- AF frequently coexists with conditions requiring cardiac surgery, such as coronary artery disease and valvular heart disease.
- Surgical ablation, particularly the Cox-Maze IV procedure, is effective for AF management.
Purpose of the Study:
- To review the indications, efficacy, and safety of concomitant surgical ablation (CSA) for AF.
- To discuss the challenges in implementing CSA during cardiac surgical procedures.
- To encourage wider adoption of CSA when clinically indicated.
Main Methods:
- This is a review article, synthesizing existing literature on surgical ablation for AF.
- The review examines data on efficacy, safety, and implementation challenges.
- Focus is on AF treatment during concomitant cardiac surgeries like coronary revascularization and valve repair/replacement.
Main Results:
- Surgical ablation is highly effective in restoring normal sinus rhythm.
- CSA demonstrates efficacy in preventing atrial tachyarrhythmias and reducing stroke risk.
- The safety profile of CSA is favorable when performed with other cardiac surgeries.
Conclusions:
- Despite strong guideline recommendations, CSA for AF is underutilized.
- Multidisciplinary heart teams should consider CSA for eligible AF patients undergoing cardiac surgery.
- Addressing implementation challenges is key to increasing CSA adoption.
Abstract:
Atrial fibrillation (AF) is the most prevalent arrhythmia and is often found during times of other cardiac pathologies that require surgical management including coronary revascularization and valve surgery. Surgical ablation of AF, most frequently performed through the Cox-Maze IV procedure, is highly effective in restoring sinus rhythm. Despite robust society guideline recommendations for concomitant surgical ablation (CSA) for AF, the practice has yet to be widely adopted. In this review, we discuss the current indications for CSA, its efficacy in maintaining freedom from atrial tachyarrhythmias, stroke, and adverse long-term outcomes, the safety profile of SA when performed alongside cardiac surgical cases, and challenges with its implementation across the most common concomitant cardiac operations. In conclusion, we present a reminder to multidisciplinary heart teams to consider CSA when indicated for their patients.
