Surgical therapy for atrial fibrillation

Surgical treatment of atrial fibrillation grew out of positive experiences with arrhythmia surgery. The predilection to and occurrence of AF are related to a substrate, triggers and rotors. The encouraging, initial experiences with the cut-and-sew maze procedure, developed by Cox &Boineau essentially aimed to isolate the atria electrically into small areas by scar tissue made possible by cutting and sewing along a certain pattern. The premise of that this maze of scars would allow only normal impulses to move from the atria to the ventricles is the foundation. As technology has progressed, other energy sources such as radio-frequency ablation and cryo-ablation have been used to create scars. This chapter provides an overview of the surgical approaches to creating these scars in addressing atrial fibrillation and its consequences.