The problem with concomitant atrial fibrillation in non-mitral valve surgery
Treatment of atrial fibrillation (AF) in concomitant surgery is not unanimously agreed upon in the cardiac surgical community. The reason for this lack of consensus is threefold. Firstly, there is an absence of large multicenter randomized controlled trials (RCT) proving the benefit of restoration of sinus rhythm in a patient population with whom we are confronted almost daily (about 10% of cardiac surgery patients are diagnosed with AF). Secondly, for patients that are having cardiac surgery without the need for an atriotomy, the Maze procedure is not widely accepted. In these patients, many surgeons do not think that the increased complexity outweighs the potential future benefits of sinus rhythm. Thirdly, triggered by our limited understanding of this pathology, we are confronted with many choices of ablation tools and lesion sets. In this perspective these issues are reviewed. As a possible solution, a total epicardial lesion set without any incisions is proposed.