Surgical ablation of atrial fibrillation: Rationale and technique

The Cox maze procedure is the most effective treatment for atrial fibrillation with the best long-term success rate compared to any other treatment modality, particularly in persistent and long-standing persistent atrial fibrillation. Cardiac surgeons have an unparalleled opportunity to treat atrial fibrillation as a concomitant operation during the treatment of ischemic or valvular disease. In addition, there are many options for surgical ablation of atrial fibrillation. In this review, we share the anatomic basis for surgical atrial fibrillation ablation, focusing on the Cox maze procedure and discuss some key technical points and common pitfalls to provide an effective ablation of atrial fibrillation. These include a discussion of avoidance of pacemaker implantation and other complications, and also how to produce the most effective lesions from a rhythm standpoint.