ABSTRACT
Surgical ablation can be done with acceptable CPB and aortic cross-clamp times. Cox’s operative mortality is <3% with short-and long-term freedom from AF and maintenance of sinus rhythm reported in 60-80% of patients. Overall, patients undergoing maze and mitral valve surgery have a higher rate of relapse into AF. This may be due to patient heterogeneity and variations in surgical technique/ablation lesion sets used by individual surgeons. More impressive are the consistent results of long-term freedom from thromboembolism (<1%). Restoration of SR is important, but LA appendagectomy and LA reduction (when LA>7 cm) also play important roles in preventing thromboembolism. It is unclear why Cox’s series demonstrated a 5% incidence of permanent pacemaker implantation; this may be due to underlying sick sinus
syndrome rather than the lesion pattern created. It is important to note that these results derive from a retrospective cohort and no randomized data exist.
