Surgical Treatment of Atrial Fibrillation

Publication Date: January 1, 2017
Last Updated: July 5, 2022

Recommendations

Surgical ablation for atrial fibrillation (AF) can be performed without additional risk of operative mortality or major morbidity, and is recommended at the time of concomitant mitral operations to restore sinus rhythm. (Level A, Class I (benefit > > >risk))
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Surgical ablation for AF can be performed without additional operative risk of mortality or major morbidity, and is recommended at the time of concomitant isolated aortic valve replacement, isolated coronary artery bypass graft surgery, and aortic valve replacement plus coronary artery bypass graft operations to restore sinus rhythm. (Level B, Class I (benefit > > >risk))
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Surgical ablation for symptomatic AF in the absence of structural heart disease that is refractory to class I/III antiarrhythmic drugs or catheter-based therapy or both is reasonable as a primary stand-alone procedure, to restore sinus rhythm. (Level B, Class IIa (benefit > > risk))
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Surgical ablation for symptomatic persistent or longstanding persistent AF in the absence of structural heart disease is reasonable, as a stand-alone procedure using the Cox-Maze III/IV lesion set compared with pulmonary vein isolation alone. (Level B, Class IIa (benefit > > risk))
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Surgical ablation for symptomatic AF in the setting of left atrial enlargement (≥4.5 cm) or more than moderate mitral regurgitation by pulmonary vein isolation alone is not recommended. (Level C, Class III (no benefit))
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It is reasonable to perform left atrial appendage excision or exclusion in conjunction with surgical ablation for AF for longitudinal thromboembolic morbidity prevention. (Level C, Class IIa (benefit > > risk))
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At the time of concomitant cardiac operations in patients with AF, it is reasonable to surgically manage the left atrial appendage for longitudinal thromboembolic morbidity prevention. (Level C, Class IIa (benefit > > risk))
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In the treatment of AF, multidisciplinary heart team assessment, treatment planning, and long-term follow-up can be useful and beneficial to optimize patient outcomes. (Level C, Class I (benefit > > >risk))
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Recommendation Grading

Disclaimer

Overview

Title

Surgical Treatment of Atrial Fibrillation

Authoring Organization

Publication Month/Year

January 1, 2017

Last Updated Month/Year

January 12, 2023

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Surgical ablation for atrial fibrillation (AF) can be performed without additional risk of operative mortality or major morbidity, and is recommended at the time of concomitant mitral operations to restore sinus rhythm. 

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Hospital, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D001281 - Atrial Fibrillation, D011182 - Postoperative Care

Keywords

atrial fibrillation, post-op management, ablation

Source Citation

The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation

Badhwar, Vinay et al.
The Annals of Thoracic Surgery, Volume 103, Issue 1, 329 - 341

Supplemental Methodology Resources

Data Supplement