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)
573
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)
573
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)
573

Recommendation Grading

Overview

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

Supplemental Implementation Tools

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

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

Supplemental Methodology Resources

Data Supplement

Methodology

Number of Source Documents
191
Literature Search Start Date
January 1, 2017
Literature Search End Date
January 1, 2023