Atrial fibrillation surgery for patients with rheumatic valve disease

Atrial fibrillation (AF) is commonly associated with rheumatic valve disease. The dilated left atrium, degeneration of the left atrial myocardium, and elevated atrial pressure all contribute to perpetuation of AF. Over the past decade, the Maze procedure has evolved into the gold standard of treatment for medically refractory AF. The atrial incisions of the Maze procedure are designed to block potential macroreentrant pathways and propagation of microreentrant wavelets. The dilated left atrium and degeneration of the atrial myocardium caused by rheumatic inflammation participate in recurrence of postoperative AF years after surgery. Increased inflammatory response correlates with occurrence of postoperative AF. Pre- and postoperative anti-inflammatory therapy might be effective in decreasing the recurrence of AF in rheumatic heart disease patients. This article reviews the mechanisms of AF and surgical procedures in rheumatic valve disease.