New strategies in the surgical treatment of atrial fibrillation.

In patients with longstanding atrial fibrillation surgical correction of the underlying cardiac abnormality alone will not abolish the arrhythmia. The Cox's Maze III has proven to be an effective treatment for atrial fibrillation but because of its complexity cardiac surgeons are reluctant to expose their patients to the potential risks of this procedure. Attempts have been made to simplify the Cox's Maze III procedure by using alternative energy sources and modifying the pattern of atrial lines of conduction block. In patients with atrial fibrillation without structural heart disease Maze surgery may be an option as an ultimate therapeutic alternative when atrial fibrillation is drug resistant and very symptomatic. The objective of this article is to outline the different surgical procedures that have formerly been used in the treatment of atrial fibrillation and to give an overview of new and evolving techniques.