Surgical treatment of atrial fibrillation

ABSTRACT

Despite its proven efficacy in the treatment of atrial fibrillation (AF), the Cox-Maze III procedure has not been widely accepted owing to its complexity and technical difficulty. New ablation technologies have led to the development of various simplified lesion sets, including minimally invasive techniques. Given recent improvements in the percutaneous catheter ablation technique, it seems to have replaced surgical treatment of AF, especially for lone AF. However, suboptimal results of catheter ablation have been reported, and it has been well established that the Cox-Maze III procedure is still the gold standard for surgical AF ablation. Nevertheless, many physicians and patients are reluctant to undergo surgery for lone AF because of its invasiveness. In this regard, improvements in minimally invasive technology should be directed toward replicating the original Cox-Maze III technique and ultimately on performing it on the beating heart without cardiopulmonary bypass. This review provides an overview of the current state of the art and future directions in the surgical treatment of AF. Based on a better understanding of the mechanisms of AF and various treatment techniques, and improvements in diagnostic techniques, the appropriate option among various surgical techniques should be selected tailored to individual patients, making the surgical treatment of AF available to a larger population of patients.