Surgical Treatment of Atrial Fibrillation: A Review

Abstract

Atrial fibrillation is the most commonly sustained arrhythmia in man. While it affects millions of patients worldwide, its incidence will markedly increase with an aging population. Primary goals of AF therapy are to (1) reduce embolic complications, particularly stroke, (2) alleviate symptoms, and (3) prevent long-term heart remodelling. These have been proven to be a challenge as there are major limitations in our knowledge of the pathological and electrophysiological mechanisms underlying AF. Although advances continue to be made in the medical management of this condition, pharmacotherapy is often unsuccessful. Because of the high recurrence rate of AF despite antiarrhythmic drug therapy for maintenance of sinus rhythm and the adverse effects of these drugs, there has been growing interest in nonpharmacological strategies. Surgery for treatment of AF has been around for some time. The Cox-Maze procedure is the gold standard for the surgical treatment of atrial fibrillation and has more than 90% success in eliminating atrial fibrillation. Although the cut and sew maze is very effective, it has been superseded by newer operations that rely on alternate energy sources to create lines of conduction block. In addition, the evolution of improved ablation technology and instrumentation has facilitated the development of minimally invasive approaches. In this paper, the rationale for surgical ablation for atrial fibrillation and the different surgical techniques that were developed will be explored. In addition, it will detail the new approaches to surgical ablation of atrial fibrillation that employ alternate energy sources.

A rare appearance of a large mural thrombus in left atrium detected two years after the Maze procedure

“…Although arrhythmia, e.g. sinus bradycardia, is a well-known postoperative complication of the Maze procedure [2], only a few reports have described thrombus formation in the left atrium (LA) after this procedure [3,4]. We experienced a case in which a rare appearance of a large mural thrombus was detected in the LA as late as two years after the Maze procedure.…”

Predictive risk factors for recurrent atrial fibrillation after modified endoscopic ablation: A 2‐year follow‐up

“…endoscopic ablation. 10 Several single-center studies reported overall 1-year freedom from AF between 62% and 80%. 7,[11][12][13] The longest follow-up was reported by Hu and colleagues.…”

Aortic Valve Stenosis - Current View on Diagnostics and Treatment

“…Patients who return to SR after mitral valve replacement or repair demonstrate better survival and freedom from adverse events. After the success of the Cox maze III procedure in treating AF, several surgeons began to add the maze procedure as an adjunct to mitral valve surgery to treat both problems 81 . Successful restoration of SR has been achieved in 70-96% of patients.…”