Contemporary surgical treatment for atrial fibrillation

Traditional surgical treatment of AF is the Cox-Maze III procedure. The Cox-Maze III procedure cures AF in >90% of patients and virtually eliminates the risk of stroke. Recent understanding of the importance of the pulmonary veins and left atrium in the pathogenesis of AF has resulted in the development of new surgical approaches. New operations to ablate AF use alternate energy sources (radiofrequency, microwave, cryothermy) and simplified left atrial lesion sets. These operations cure AF in 70-80% of patients. This article describes contemporary and emerging surgical approaches to AF, synthesizes results of these operations, and proposes a strategy for choice of operation based on patient presentation.