Surgical ablation to prevent recurrent atrial fibrillation
- Richard Lee, MD, MBA
Richard Lee, MD, MBA
- Professor of Surgery
- Co-Director, Center for Comprehensive Cardiovascular Care
- St. Louis University
- Section Editors
- Gabriel S Aldea, MD
Gabriel S Aldea, MD
- Section Editor — Cardiac Surgery
- Professor of Surgery
- University of Washington
- Edward Verrier, MD
Edward Verrier, MD
- Section Editor — Cardiac Surgery
- Professor of Surgery
- University of Washington School of Medicine
- Bradley P Knight, MD, FACC
Bradley P Knight, MD, FACC
- Section Editor — Cardiac Arrhythmias
- Professor of Medicine
- Feinberg School of Medicine, Northwestern University
Atrial fibrillation (AF) is associated with an increased risk for stroke, heart failure, and death. An attempt to maintain sinus rhythm is made in patients based on the presence or absence of symptoms and evidence that myocardial function is being compromised. This may involve pharmacologic and nonpharmacologic strategies.
The most commonly performed invasive procedure used in an attempt to maintain sinus rhythm is catheter ablation performed by an electrophysiologist in a specially designed hospital procedure room. This technique is discussed in detail elsewhere. (See "Catheter ablation to prevent recurrent atrial fibrillation: Technical considerations".)
This chapter focuses on the surgical ablation for the prevention of recurrent atrial fibrillation. The role of nonpharmacologic strategies for rate control in AF or to minimize thrombotic risk by left atrial appendage ligation, and an overview of the management of patients with AF are presented separately. (See "Control of ventricular rate in atrial fibrillation: Nonpharmacologic therapy" and "Nonpharmacologic therapy to prevent embolization in patients with atrial fibrillation" and "Overview of atrial fibrillation".)
Work on the arrhythmic mechanisms for atrial fibrillation (AF) has led to a greater appreciation for the underlying process by which premature atrial depolarization can promote areas of microreentry within the atrium that ultimately lead to AF. (See "Mechanisms of atrial fibrillation".)
Several surgical techniques have been developed to maintain sinus rhythm. In most patients, these techniques are employed in patients who are undergoing other cardiac surgery for some other reason (valve repair or replacement, coronary bypass grafting, or corrective surgery for congenital heart disease).
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- MAZE PROCEDURE
- Traditional approach
- Radial approach
- Minimally invasive approach
- Limitations and complications
- ENDOCARDIAL SURGICAL ABLATION
- EPICARDIAL PROCEDURES
- COMPARISON OF METHODS
- HYBRID APPROACH
- TREATMENT FAILURES
- LONG-TERM STROKE RISK AND ANTICOAGULATION
- RECOMMENDATIONS OF OTHERS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS