Strategies in the Surgical Management of Atrial Fibrillation

Table 4

Comparison of ablative modalities.

	Transmurality	Endocardial	Epicardial	Advantages	Potential complications	Use outside research and clinical trials	Accuracy (width/depth ratio)
Radiofrequency	Variable improved with bipolar devices	Yes	Yes	Able to produce fast and effective lesion set	Risk of inter-cavity thrombus formation, char formation, collateral damage to circumflex artery and oesophagus and PV stricture	Yes	Moderate
Cryoablation	Good	Yes	Yes	Preserves cellular architecture and capable of producing mitral and tricuspid isthmus lesions. Minimal collateral damage, able to produce  well-demarcated lesion, adheres to myocardium to produce good contact with tissue, low risk of bleeding or perforation	Potential risk of coronary artery damage	Yes	Moderate
Microwave	Variable	Yes	Yes	Lower risk of thromboembolism, minimal char formation, and minimal collateral damage	Potential for circumflex artery damage	Yes	Good
High Frequency Ultrasound	Excellent	No	Yes	Advantage of fast, transmural epicardial lesions with theoretical potential to visualize wall thickness and perform tailor made lesion	Risk of collateral damage and perforation	No	Poor
Laser	Excellent	Yes	Yes	Able to produce fast, deep, and uniform lesions	Risk of crater formation and perforation	No	Poor