Surgical ablation for atrial fibrillation

Abstract

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

Effect of intralipid on myocardial injury during valve replacement surgery with concomitant radiofrequency ablation

“…The rate of freedom from AF at 6 months was higher than that reported in related studies (91.3% vs 66%–74%). [ 1 , 14 , 26 ] However, the present study is a single center, assessor-blinded trial without Holter for monitoring recurrent AF after ablation, which might have result in missing some patients with asymptomatic AF recurrence in nonfollow-up day. This limitation and the small number of patients might be the reason for the low recurrence of AF.…”

Comparison between biparietal bipolar and uniparietal bipolar radio frequency ablation techniques in a simultaneous procedural setting

“…The bipolar setting in ablation procedures seems to offer a higher rate of transmurality [ 16 , 17 ] in comparison with unipolar technique. Especially, the use of biparietal bipolar clamp in either open chest surgery or mini-invasive thoracoscopic approach seems to represent the gold standard in AF, creating transmural, long-lasting, and reliable lesions [ 3 , 18 ]. Another important aspect is represented by the lacking of the cooling circulating blood flow effect.…”

Concomitant Atrial Fibrillation Surgery

“…Patients who are in AF at the time of surgery and have no intracardiac thrombosis on intraoperative transesophageal echocardiogram are electrically cardioverted and started on intravenous amiodarone. Pacing thresholds are measured from each pulmonary vein [2,50].…”