When to consider surgery for atrial fibrillation

The ESC/EHRA guidelines suggest considering minimally invasive surgery with epicardial pulmonary vein isolation in patients with symptomatic AF after catheter ablation fails. Maze surgery, possibly using a minimally invasive technique, is an option for symptomatic and refractory persistent AF or AF that persists after ablation to improve symptoms.5

The guidelines also suggest considering maze surgery, preferably on both atria, for patients undergoing cardiac surgery to improve AF symptoms. Clinicians should balance the added risk of the procedure against the benefit of rhythm control therapy. Surgeons could also consider maze surgery on both atria or pulmonary vein isolation in asymptomatic AF patients who are undergoing cardiac surgery for another indication.5

Treatment decisions should be based on risk, visit the next section to learn about patient stratification


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