Surgical Ablation for Atrial Fibrillation

From the Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH, and Center for Surgical Innovation, The University of Cincinnati, Cincinnati, OH. Address reprint requests to A Marc Gillinov, MD, Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation/F24, 9500 Euclid Avenue, Cleveland, OH 44195. E-mail: gillinom@ccf.org 0033-0620/$ see front matter n 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.pcad.2005.06.012 Surgical ablation of atrial fibrillation (AF) is the most effective means of curing this arrhythmia, with the classic Maze procedure eliminating AF in more than 90% of patients. A complex but safe operation, the Maze procedure has been applied by relatively few surgeons. However, recent advances in the understanding of the pathogenesis of AF and development of new ablation technologies enable surgeons to perform pulmonary vein ablation, create linear left atrial lesions, and remove the left atrial appendage rapidly and safely. Lesions are created under direct vision, minimizing the risk of damage to the pulmonary veins and adjacent mediastinal structures. Most surgical ablation procedures have been performed in conjunction with mitral valve surgery, the combination of mitral valve repair and cure of AF enabling patients to avoid lifelong anticoagulation. Recently developed surgical instrumentation now enables thoracoscopic and keyhole approaches, facilitating extension of epicardial AF ablation and excision of the left atrial appendage to patients with isolated AF and no other indication for cardiac surgery. n 2005 Elsevier Inc. All rights reserved.