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  • Review Article
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Surgery for atrial fibrillation

Nature Reviews Cardiology volume 6, pages 505–513 (2009)Cite this article

Abstract

The field of atrial fibrillation is evolving rapidly. Although a medical rhythm control strategy has not proven to be beneficial for survival, new interventional therapies have improved the rate of sinus restoration and thus have the potential to improve outcomes. In particular, the maze procedure can be performed safely and cures the majority of patients with atrial fibrillation. Over the last two decades, the introduction of new ablation technologies has made the procedure much easier to perform and it is now more widely applied to patients with atrial fibrillation undergoing cardiac surgery. Minimally invasive modifications of the maze using these technologies have offered an important step towards developing a stand-alone procedure for the cure of atrial fibrillation with potentially decreased morbidity. We review the magnitude of the problem, the history of past surgical treatments, current surgical options and the future direction of surgical therapy.

Key Points

  • Medical rhythm control has not proven beneficial for survival

  • New interventional therapies have improved the rate of sinus restoration

  • The maze procedure offers a high chance of sinus restoration and may reduce stroke in patients with atrial fibrillation

  • The maze procedure is currently the standard of care for patients with atrial fibrillation undergoing cardiac surgery

  • New minimally invasive techniques are under investigation for lone atrial fibrillation

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Figure 1: The 'corridor' procedure for AF.
Figure 2: The surgical maze.
Figure 3: Bipolar radiofrequency ablation using Cardioblate® BP2 (Medtronic, Inc., Minneapolis, MN).

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Acknowledgements

Charles P. Vega, University of California, Irvine, CA is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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  1. Division of Cardiothoracic Surgery, Bluhm Cardiovascular Institute, Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Richard Lee, Jane Kruse & Patrick M. McCarthy

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Richard Lee serves as a consultant for Medtronic. Jane Kruse and Patrick McCarthy declare no competing interests.

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Lee, R., Kruse, J. & McCarthy, P. Surgery for atrial fibrillation. Nat Rev Cardiol 6, 505–513 (2009). https://doi.org/10.1038/nrcardio.2009.106

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