Treatment of lone atrial fibrillation: A look at the past, a view of the present and a glance at the future

Sandro Gelsomino, Mark La Meir, Fabiana Lucdá, Roberto Lorusso, Elena Crudeli, Ludovico Vasquez, Gian Franco Gensini, Jos Maessen

Research output: Contribution to journalArticle

Abstract

Despite its proven efficacy, the Cox-Maze III procedure did not gain widespread acceptance for the treatment of lone atrial fibrillation (LAF) because of its complexity and technical difficulty. Surgical ablation for LAF can now be successfully performed utilizing minimally invasive techniques. This article provides an overview of the current state of the art in the surgical treatment of LAF. A brief review of pathophysiology, pharmacological treatment as well as catheter ablation is also provided. The most widely employed minimally invasive approach to LAF has been the video-assisted bilateral mini-thoracotomy or thoracoscopic pulmonary vein island creation and left atrial appendage removal or exclusion, usually with ganglionic plexi evaluation and destruction. Recently, a hybrid approach has been introduced, which combines a mono or bilateral epicardial approach with a percutaneous endocardial ablation in a single-step procedure to limit the shortcomings of both techniques. Suboptimal results of both catheter ablation and surgery suggest that success in the treatment of LAF will probably rely on a close collaboration between the surgeon and the electrophysiologist. Further studies are warranted to determine whether the hybrid approach is effective, especially in patients with long-standing persistent and persistent LAF.

Original languageEnglish
Pages (from-to)1284-1294
Number of pages11
JournalEuropean Journal of Cardio-thoracic Surgery
Volume41
Issue number6
DOIs
Publication statusPublished - 2012

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Keywords

  • Ablation
  • Atrial fibrillation
  • Surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Gelsomino, S., Meir, M. L., Lucdá, F., Lorusso, R., Crudeli, E., Vasquez, L., Gensini, G. F., & Maessen, J. (2012). Treatment of lone atrial fibrillation: A look at the past, a view of the present and a glance at the future. European Journal of Cardio-thoracic Surgery, 41(6), 1284-1294. https://doi.org/10.1093/ejcts/ezr222