Surgical Treatment of Atrial Fibrillation

  • Gino Gerosa
  • Carlo Dal Lin
  • Vincenzo Tarzia


Because of disappointing results with medical strategies of rate and rhythm control, there has been strong interest in the nonpharmacological treatment of atrial fibrillation (AF), leading to the development of various interventional catheter and surgical therapies. In 1980, Williams et al. developed the “left atrial isolation procedure” confining the AF to the left atrium and restoring the remainder of the heart to sinus rhythm. In 1982 Scheimnman et al. described the “catheter fulguration of the His bundle,” thus confining the arrhythmia to the atria and implanting a pacemaker to restore a normal ventricular rhythm. After Guiraudon et al. description of the “Corridor procedure” (1985), Cox et al. developed the “atrial transection procedure” in a canine model of AF, observing that a single long incision across both atria down into the septum cured AF. Nowadays, the Cox-Maze III procedure represents the gold standard for surgical management of AF and has recently given way to a variety of simpler operations that employ alternative energy sources and lesion sets to treat AF.


Atrial Fibrillation Pulmonary Vein Pulmonary Vein Isolation Left Atrial Appendage Mitral Valve Disease 
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  1. 1.
    Williams JM, Ungerleider RM, Lofland GK et al (1980) Left atrial isolation: new technique for the treatment of supraventricular arrhythmias. J Thorac Cardiovasc Surg 80(3):373–380PubMedGoogle Scholar
  2. 2.
    Scheinman MM, Morady F, Hess DS et al (1982) Catheter-induced ablation of the atrioventricular junction to control refractory supraventricular arrhythmias. JAMA 248(7):851–855PubMedCrossRefGoogle Scholar
  3. 3.
    Guiraudon GM, Campbell CS, Jones DL et al (1985) Combined sinoatrial node atrioventricular node isolation: a surgical alternative to his bundle ablation in patients with atrial fibrillation. Circulation 72 [Suppl 3]:220Google Scholar
  4. 4.
    Smith PK, Holman WL, Cox JL (1985) Surgical treatment of supraventricular tachyarrhythmias. Surg Clin North Am 65(3):553–570PubMedGoogle Scholar
  5. 5.
    Cox JL, Boineau JP, Schuessler RB et al (1995) Modification of the Maze procedure for atrial flutter and atrial fibrillation. I. Rationale and surgical results. J Thorac Cardiovasc Surg 110(2):473–484PubMedCrossRefGoogle Scholar
  6. 6.
    Prasad SM, Maniar HS, Camillo CJ et al (2003) The Cox Maze III procedure for atrial fibrillation: long-term efficacy in patients undergoing lone versus concomitant procedures. J Thorac Cardiovasc Surg 126(6):1822–1828PubMedCrossRefGoogle Scholar
  7. 7.
    Cox JL (2011) The first Maze procedure. J Thorac Cardiovasc Surg 141(5):1093–1097PubMedCrossRefGoogle Scholar
  8. 8.
    Cox JL, Canavan TE, Schuessler RB et al (1991) The surgical treatment of atrial fibrillation. II. Intraoperative electrophysiologic mapping and description of the electrophysiologic basis of atrial flutter and atrial fibrillation. J Thorac Cardiovasc Surg 101(3):406–426PubMedGoogle Scholar
  9. 9.
    Cox JL, Schuessler RB, D’Agostino HJ Jr et al (1991) The surgical treatment of atrial fibrillation. III. Development of a definitive surgical procedure. J Thorac Cardiovasc Surg 101(4):569–583PubMedGoogle Scholar
  10. 10.
    Cox JL (1991) The surgical treatment of atrial fibrillation. IV. Surgical technique. J Thorac Cardiovasc Surg 101(4):584–592PubMedGoogle Scholar
  11. 11.
    Marc Gillinov A (2007) Surgical treatment of atrial fibrillation. In: Kaiser L, Kron I, Spray T (eds) Mastery of cardiothoracic surgery. Lippincott Williams & Wilkins, Philadelphia, pp 606–611Google Scholar
  12. 12.
    Gaynor SL, Diodato MD, Prasad SM et al (2004) A prospective, single-center clinical trial of a modified Cox Maze procedure with bipolar radiofrequency ablation. J Thorac Cardiovasc Surg 128(4):535–542PubMedCrossRefGoogle Scholar
  13. 13.
    Lall SC, Melby SJ, Voeller RK, Zierer A, Bailey MS, Guthrie TJ, Moon MR, Moazami N, Lawton JS, Damiano RJ Jr (2007) The effect of ablation technology on surgical outcomes after the Cox-Maze procedure: a propensity analysis. J Thorac Cardiovasc Surg 133(2):389–396PubMedCrossRefGoogle Scholar
  14. 14.
    Damiano RJ Jr, Schwartz FH, Bailey MS, Maniar HS, Munfakh NA, Moon MR, Schuessler RB (2011) The Cox Maze IV procedure: predictors of late recurrence. J Thorac Cardiovasc Surg 141(1):113–121PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Damiano RJ Jr, Schuessler RB, Voeller RK (2007) Surgical treatment of atrial fibrillation: a look into the future. Semin Thorac Cardiovasc Surg 19(1):39–45PubMedCrossRefGoogle Scholar
  16. 16.
    Prasad SM, Maniar HS, Schuessler RB et al (2002) Chronic transmural atrial ablation by using bipolar radiofrequency energy on the beating heart. J Thorac Cardiovasc Surg 124(4):708–713PubMedCrossRefGoogle Scholar
  17. 17.
    Prasad SM, Maniar HS, Diodato MD et al (2003) Physiological consequences of bipolar radiofrequency energy on the atria and pulmonary veins: a chronic animal study. Ann Thorac Surg 76(3):836–841PubMedCrossRefGoogle Scholar
  18. 18.
    Gaynor SL, Ishii Y, Diodato MD et al (2004) Successful performance of Cox Maze procedure on beating heart using bipolar radiofrequency ablation: a feasibility study in animals. Ann Thorac Surg 78(5):1671–1677PubMedCrossRefGoogle Scholar
  19. 19.
    Khargi K, Deneke T, Haardt H et al (2001) Saline-irrigated, cooled-tip radiofrequency ablation is an effective technique to perform the Maze procedure. Ann Thorac Surg 72(3):S1090–S1095PubMedCrossRefGoogle Scholar
  20. 20.
    Kottkamp H, Hindricks G, Autschbach R et al (2002) Specific linear left atrial lesions in atrial fibrillation: Intraoperative radiofrequency ablation using minimally invasive surgical techniques. J Am Coll Cardiol 40(3):475–480PubMedCrossRefGoogle Scholar
  21. 21.
    Gaita F, Riccardi R, Caponi D et al (2005) Linear cryoablation of the left atrium versus pulmonary vein cryoisolation in patients with permanent atrial fibrillation and valvular heart disease: correlation of electroanatomic mapping and long-term clinical results. Circulation 111(2):136–142PubMedCrossRefGoogle Scholar
  22. 22.
    Kondo N, Takahashi K, Minakawa M et al (2003) Left atrial Maze procedure: a useful addition to other corrective operations. Ann Thorac Surg 75(5):1490–1494PubMedCrossRefGoogle Scholar
  23. 23.
    Salenger R, Lahey SJ, Saltman AE (2004) The completely endoscopic treatment of atrial fibrillation: report on the first 14 patients with early results. Heart Surg Forum 7(6):E555–E558PubMedCrossRefGoogle Scholar
  24. 24.
    Tada H, Ito S, Naito S et al (2005) Long-term results of cryoablation with a new cryoprobe to eliminate chronic atrial fibrillation associated with mitral valve disease. Pacing Clin Electrophysiol 28 [Suppl 1]:S73–S77PubMedCrossRefGoogle Scholar
  25. 25.
    Geidel S, Lass M, Boczor S et al (2004) Monopolar and bipolar radiofrequency ablation surgery: 3 year experience in 90 patients with permanent atrial fibrillation. Heart Surg Forum 7(5):E398–E402PubMedCrossRefGoogle Scholar
  26. 26.
    Saltman AE (2007) Minimally invasive surgery for atrial fibrillation. Semin Thorac Cardiovasc Surg 19(1):33–38PubMedCrossRefGoogle Scholar
  27. 27.
    Sales VL, McCarthy PM (2010) Minimally invasive surgery for atrial fibrillation. Tex Heart Inst J 37(6):660–661PubMedCentralPubMedGoogle Scholar
  28. 28.
    Wolf RK (2007) Minimally invasive surgical treatment of atrial fibrillation. Semin Thorac Cardiovasc Surg 19(4):311–318PubMedCrossRefGoogle Scholar
  29. 29.
    Gerosa G, Bianco R, Buja G, di Marco F (2004) Totally endoscopic robotic-guided pulmonary veins ablation: an alternative method for the treatment of atrial fibrillation. Eur J Cardiothorac Surg 26(2):450–452PubMedCrossRefGoogle Scholar
  30. 30.
    Saltman AE, Rosenthal LS, Francalancia NA, Lahey SJ (2003) A completely endoscopic approach to microwave ablation for atrial fibrillation. Heart Surg Forum 6(3):E38–E41PubMedGoogle Scholar
  31. 31.
    Bisleri G, Muneretto C (2005) Innovative monolateral approach for closed-chest atrial fibrillation surgery. Ann Thorac Surg 80(5):e22–e25PubMedCrossRefGoogle Scholar
  32. 32.
    Klinkenberg TJ, Ahmed S, Ten Hagen A, Wiesfeld AC, Tan ES, Zijlstra F, Van Gelder IC (2009) Feasibility and outcome of epicardial pulmonary vein isolation for lone atrial fibrillation using minimal invasive surgery and high intensity focused ultrasound. Europace 11(12):1624–1631PubMedCrossRefGoogle Scholar
  33. 33.
    Speziale G, Bonifazi R, Nasso G, Bartolomucci F, Caldarola P, Fattouch K, Martines G, Tavazzi L, Chierchia SL (2010) Minimally invasive radiofrequency ablation of lone atrial fibrillation by monolateral right minithoracotomy: operative and early follow-up results. Ann Thorac Surg 90(1):161–167PubMedCrossRefGoogle Scholar
  34. 34.
    Wolf RK, Schneeberger EW, Osterday R, Miller D, Merrill W, Flege JB et al (2005) Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation. J Thorac Cardiovasc Surg 130(3):797–802PubMedCrossRefGoogle Scholar
  35. 35.
    Lecoq RR, Gracia JM, Sureda C, Igual A (2006) Subxyphoid approach for closed-chest atrial fibrillation surgery: the one hand operation. Interact Cardiovasc Thorac Surg 5(6):669–671PubMedCrossRefGoogle Scholar
  36. 36.
    Krul SP, Driessen AH, van Boven WJ, Linnenbank AC, Geuzebroek GS, Jackman WM, Wilde AA, de Bakker JM, de Groot JR (2011) Thoracoscopic video-assisted pulmonary vein antrum isolation, ganglionated plexus ablation, and periprocedural confirmation of ablation lesions: first results of a hybrid surgical-electrophysiological approach for atrial fibrillation. Circ Arrhythm Electrophysiol 4(3):262–270PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2013

Authors and Affiliations

  1. 1.Division of Cardiac SurgeryDepartment of Cardiac Thoracic and Vascular Sciences, University of PadovaPaduaItaly
  2. 2.Division of CardiologyDepartment of Cardiac Thoracic and Vascular Sciences, University of PadovaPaduaItaly

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