Surgical Treatment of Atrial Fibrillation
Publication Date: January 23, 2024
Last Updated: January 29, 2024
Summary of Recommendations
Surgical ablation for atrial fibrillation (atrial fibrillation) is recommended for firsttime non-emergent concomitant mitral operations to restore sinus rhythm and improve long-term outcome. (I, A)
573
Surgical ablation for atrial fibrillation is recommended for any first-time nonemergent concomitant non-mitral operation to restore sinus rhythm and improve long-term outcomes. (I, B-NR)
573
Surgical ablation for symptomatic atrial fibrillation in the absence of structural heart disease refractory to class I/III antiarrhythmic drugs, catheter-based therapy, or both is reasonable as a primary stand-alone procedure to restore sinus rhythm. (IIa, B-NR)
573
Surgical ablation for symptomatic persistent or longstanding persistent atrial fibrillation in the absence of structural heart disease is reasonable as a stand-alone procedure using the Cox-Maze III/IV lesion set as the preferred procedure. (IIa, B-NR)
573
Surgical ablation for symptomatic atrial fibrillation in the setting of left atrial enlargement (≥4.5 cm) or more than moderate mitral regurgitation by pulmonary vein isolation alone is not recommended. (III - No Benefit, C-LD)
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Left atrial appendage obliteration for atrial fibrillation is recommended for all firsttime non-emergent cardiac surgery procedures, with or without concomitant surgical ablation, to reduce morbidity from thromboembolic complications. (I, A)
573
Isolated surgical left atrial appendage obliteration may be considered in patients with longstanding persistent atrial fibrillation, a high stroke risk, and contraindications for or failure of long-term oral anticoagulation. (IIb, B-NR)
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For patients with symptomatic valve disease and atrial fibrillation, who are deemed of low to intermediate surgical risk, surgical valve repair or replacement with concomitant surgical ablation and left atrial appendage occlusion is reasonable over isolated transcatheter valve repair or replacement alone to restore sinus rhythm and improve long-term outcomes. (IIa, B-NR)
573
Multidisciplinary heart team assessment and treatment planning as well as longterm follow-up using periodic continuous electrocardiographic monitoring for rhythm assessment, are recommended to optimize patient outcomes. (I, C-LD)
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Title
Surgical Treatment of Atrial Fibrillation
Authoring Organization
Society of Thoracic Surgeons
Publication Month/Year
January 23, 2024
Last Updated Month/Year
February 2, 2024
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
Male, Female, Adult, Older adult
Health Care Settings
Hospital, Operating and recovery room
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Assessment and screening, Treatment, Management
Diseases/Conditions (MeSH)
D001281 - Atrial Fibrillation, D011182 - Postoperative Care
Keywords
atrial fibrillation, post-op management, ablation
Source Citation
Wyler von Ballmoos MC, Hui DS, Mehaffey JH, Malaisrie SC, Vardas PN, Gillinov AM, Sundt TM, Badhwar V, The Society of Thoracic Surgeons 2023 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation, The Annals of Thoracic Surgery (2024), doi: https://doi.org/10.1016/j.athoracsur.2024.01.007
Methodology
Number of Source Documents
191
Literature Search Start Date
January 1, 2017
Literature Search End Date
January 1, 2023