Current Status of Atrial Fibrillation Ablation Surgery.

OBJECTIVES

Atrial fibrillation (AF) is associated with stroke, congestive heart failure, and mortality. Treatment has evolved from the cut-and-sew Cox-Maze III procedure to energy-based ablation using cryoablation and radiofrequency ablation, often via minimally invasive approaches. This review aims to establish standardized definitions and reporting practices for rhythm outcomes after surgical AF ablation.

METHODS

In this review, we establish a definition for rhythm success that can be used to compare outcomes across various types of catheter and surgical ablation. We examine biatrial versus uniatrial ablation and the lesion sets that should be recomended for paroxysmal versus persistent AF. We discuss ablation performed during coronary artery bypass grafting, aortic valve replacement, and mitral valve replacement. We also review minimally invasive thoracoscopic and hybrid ablation approaches.

RESULTS

We suggest standardizing rhythm monitoring and reporting using electrocardiograms, Holter monitors, mobile devices, and implantable loop recorders. We suggest standardizing antiarrhythmic drug use, both within and after the blanking period, and describe how use of these medications should affect reporting of ablation success. Description of a detailed lesion set and the mode of application by type of device and cardiopulmonary bypass status are also warranted.

CONCLUSIONS

Standardized reporting of rhythm outcomes is essential in clinical reports of surgical ablation. Detailed description of the mechanism of lesion application is often missing and should be included in research reports as lesion integrity as part of the ablation scheme is a key factor in success. Superior rhythm outcomes with equivalent morbidity and mortality are obtainable with a complete Maze procedure performed via right thoracotomy.