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Cardiology Research and Practice
Volume 2011, Article ID 746054, 4 pages
Review Article

Current State of the Surgical Treatment of Atrial Fibrillation

Department of Cardiovascular Surgery, Institut Clínic del Tòrax, Hospital Clínic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain

Received 14 December 2010; Accepted 19 January 2011

Academic Editor: Adrian Baranchuk

Copyright © 2011 Elena Sandoval et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Surgery of atrial fibrillation (AF) was first described in 1991 by James Cox in what was named the Cox-Maze procedure, and over the years it has been considered the gold-standard treatment, with best results in maintaining sinus rhythm in the long term. Nevertheless, the complexity and aggressivity of the first techniques of cut-and-sew limited the application of this procedure, and few centers were dedicated to AF surgery. In the past years, however, new devices able to ablate atrial tissue with cryotherapy, radiofrequency, or ultrasounds have facilitated this operation. In the mid-term, other energy devices with laser or microwave have been abandoned due to a lack of consistency in getting transmural lesions in a consistent and reproducible manner. Additionally, better knowledge of the physiopathology of AF, with the importance of triggering zones around the pulmonary veins, has started new minimally invasive techniques to approach paroxysmal and persistent AF patients through thoracoscopy.