The Surgical Treatment for Atrial Fibrillation: Ablation Technology and Surgical Approaches

Abstract

The Cox maze procedure developed originally in 1987 by Dr James Cox has evolved from a “cut and sew” surgical procedure, where the maze was applied using multiple surgical cuts, to an extensive use of surgical ablation technology where ablation lesions are placed with alternative energy sources (radiofrequency, cryothermy, microwave, and high-frequency ultrasound). Furthermore, the procedure has changed from a median sternotomy approach only to one that can be performed minimally invasively and robotically. The purpose of this paper is to review the current available technology for the ablation of atrial fibrillation as well as the different procedural approaches for the surgical ablation of atrial fibrillation.

Freezing Equals Freezing? Performance of Two Cryoablation Devices in Concomitant Mitral Valve Repair

“…According to recent literature, the addition of surgical ablation using cryoenergy devices in concomitant AF has shown to restore sinus rhythm in approximately 80%. 15 Overall, our data compare well with these findings and could confirm the efficacy of concomitant AF ablation independently from type or duration of AF.…”

Biatrial ablation versus limited right atrial ablation for atrial fibrillation associated with atrial septal defect in adults

“…concomitant surgical aF radiofrequency ablation is recognized as an effective way to eliminate aF for patients with aF and structural heart disease [6,7,11]. However, it remains unclear whether biatrial ablation is more effective and safer than limited left or right atrial ablation [8-10, 12, 13].…”

“…The Maze procedure is used widely in clinical practice and recognized as the most effective method to cure aF, but it is complex and difficult [4,5]. Surgical radiofrequency (rF) ablation has emerged as another effective treatment for aF associated with cHD [6,7]. now, either limited right atrial or biatrial rF ablation is used to treat aF associated with aSD, but it remains controversial whether biatrial rF ablation is superior to limited right atrial rF ablation for persistent or long-standing persistent aF associated with aSD [8][9][10].…”

Fragmentaiom operation in left atrium for correction of isolated mitral valve disease

“…The presence of arrhythmias in patients with mitral defect reduces the performance of the heart by 38-39% [3,4]. This is especially important in patients with artificial heart valves as the presence of arrhythmias lead not only to progressive heart failure and also creates conditions for thrombosis, embolism that leads to impaired graft function [1][2][3]. In this regard, it is important to restore the proper rhythm is already in the early postoperative period.…”