Surgery for Atrial Fibrillation

Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide (Centers for Disease Control and Prevention, National Center for Health Statistics, About Multiple Cause of Death, 1999–2019. CDC WONDER Online Database website. Centers for Disease Control and Prevention, Atlanta, GA, 2019). Its impact on patients is broad, ranging from mild to severe, debilitating symptoms and to the most feared complication of AF, stroke (Cohn, Cardiac Surgery in the Adult, McGraw-Hill Medical, 2012; Benjamin et al. Circulation 139:e56–528, 2019). Treatments include pharmacotherapies and surgical or catheter-based interventions. The Cox-Maze procedure for surgical treatment of AF was developed by Dr. James Cox and colleagues and first clinically performed in 1987 (Ferguson and Jalife, Cardiac electrophysiology: from cell to bedside, Saunders, Philadelphia, 1567, 1995; Cox, J Thorac Cardiovasc Surg 101:584, 1991). It treats AF through a series of surgical incisions in the left and right atria that act to eliminate abnormal re-entrant circuits and restore sinus rhythm. The Cox-Maze procedure has become the foundation for all procedural and surgical AF interventions and is the current gold standard for surgical treatment of AF (Cox, Adv Card Surg 6:6–1, 1995). Additional interventional treatments for AF include pulmonary vein isolation, which isolates the triggers that most commonly induce paroxysmal AF and decreases the likelihood of AF episode occurrence. Finally, occlusion of the left atrial appendage is commonly performed in AF surgery in order to decrease risk of stroke (Bhadwar et al. Ann Thorac Surg. 103:329–41, 2017).