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Novel approaches for the surgical treatment of atrial fibrillation: Time for a guideline revision?

Authors De Cecco C, Buffa V, David V, Fedeli S

Published 9 June 2010 Volume 2010:6 Pages 439—447

DOI https://doi.org/10.2147/VHRM.S6962

Review by Single-blind

Peer reviewer comments 3


Carlo Nicola De Cecco1,2, Vitaliano Buffa1, Vincenzo David2, Stefano Fedeli1

1Department of Cardiovascular Radiology, San Camillo-Forlanini Hospital, 2Department of Radiological Sciences, University of Rome, St Andrea Hospital, Rome, Italy

Abstract: Atrial fibrillation is a major health problem in Western countries, and is associated with considerable morbidity and resource consumption. Safe and reliable surgical techniques for the termination of this arrhythmia have been developed since the time of the original Cox “maze I” procedure. Novel equipment based on radiofrequency and microwave technologies can be employed to create transmural atrial lesions, even in the context of minimally invasive surgery to the atrioventricular valves via right minithoracotomy. The aim of this paper is to review the recent literature on this approach, and the clinical results in terms of arrhythmia termination and postoperative morbidity. With the aim to substantiate the practice of a simple, yet reliable, surgical ablation during minimally invasive heart valve surgery, we discuss the results of different patterns of atrial lesions having different degrees of surgical complexity. Finally, minimally invasive epicardial ablation for lone atrial fibrillation represents an emerging surgical indication. The results of state-of-the-art transcatheter ablation represent now its benchmark of comparison.
Keywords: atrial fibrillation, surgery, minimally invasive, outcomes

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