Hybrid and surgical procedures for the treatment of persistent and longstanding persistent atrial fibrillation

TY - JOUR

T1 - Hybrid and surgical procedures for the treatment of persistent and longstanding persistent atrial fibrillation

AU - Sanchez, Jose M

AU - Al-Dosari, Ghannam

AU - Chu, Sherman

AU - Beygui, Ramin

AU - Deuse, Tobias

AU - Badhwar, Nitish

AU - Lee, Randall J

PY - 2018/2

Y1 - 2018/2

N2 - INTRODUCTION: Atrial fibrillation (AF) is the most common cardiac arrhythmia. The incidence of AF increases with age and is associated with increased stroke, heart failure and mortality. Persistent and long standing persistent AF is difficult to treat and often refractory to medical therapy and catheter ablation. Areas covered: This article reviews the historical development of the surgical Cox-MAZE procedure and current hybrid and minimally invasive surgical approaches for the treatment of persistent and long standing persistent AF. The role of concomitant pulmonary vein isolation and left atrial appendage (LAA) exclusion will also be reviewed. Expert commentary: An ablation pattern emulating the Cox-Maze surgical procedure is commonly needed to obtain maintenance of sinus rhythm in patients with persistent and long standing persistent atrial fibrillation. Minimally invasive bilateral thorascopic surgical procedures can achieve a similar Cox-Maze lesion set, but are associated with increased adverse events compared to catheter ablation. Future prospective randomized studies are required to confirm whether the recently developed hybrid subxyphoid epicardial/endocardial procedure and percutaneous LAA ligation and catheter ablation are indeed as effective as surgical options with less adverse events.

AB - INTRODUCTION: Atrial fibrillation (AF) is the most common cardiac arrhythmia. The incidence of AF increases with age and is associated with increased stroke, heart failure and mortality. Persistent and long standing persistent AF is difficult to treat and often refractory to medical therapy and catheter ablation. Areas covered: This article reviews the historical development of the surgical Cox-MAZE procedure and current hybrid and minimally invasive surgical approaches for the treatment of persistent and long standing persistent AF. The role of concomitant pulmonary vein isolation and left atrial appendage (LAA) exclusion will also be reviewed. Expert commentary: An ablation pattern emulating the Cox-Maze surgical procedure is commonly needed to obtain maintenance of sinus rhythm in patients with persistent and long standing persistent atrial fibrillation. Minimally invasive bilateral thorascopic surgical procedures can achieve a similar Cox-Maze lesion set, but are associated with increased adverse events compared to catheter ablation. Future prospective randomized studies are required to confirm whether the recently developed hybrid subxyphoid epicardial/endocardial procedure and percutaneous LAA ligation and catheter ablation are indeed as effective as surgical options with less adverse events.

KW - Atrial Fibrillation/physiopathology

KW - Catheter Ablation/methods

KW - Humans

KW - Ligation

KW - Minimally Invasive Surgical Procedures/methods

KW - Pulmonary Veins/physiopathology

KW - Stroke/etiology

KW - Treatment Outcome

U2 - 10.1080/14779072.2018.1425140

DO - 10.1080/14779072.2018.1425140

M3 - SCORING: Review article

C2 - 29327638

VL - 16

SP - 91

EP - 97

JO - EXPERT REV CARDIOVAS

JF - EXPERT REV CARDIOVAS

SN - 1477-9072

IS - 2

ER -