The state of surgical ablation for atrial fibrillation in patients with mitral valve disease

Abstract

Purpose of review: Atrial fibrillation has been shown to be associated with less favorable short and long-term outcomes in patients having mitral valve surgery. Despite the growing evidence related to the potential benefits of surgical ablation for atrial fibrillation at the time of the mitral valve operation, there is a significant variability among surgeons in their approaches to atrial fibrillation. The purpose of this review is to discuss the current state of surgical ablation for atrial fibrillation as reported in the literature, as well as to discuss the significance of atrial fibrillation and the different surgical approaches to treat patients with mitral valve disease who may also concurrently suffer from tricuspid valve disease and atrial fibrillation.

Recent findings: Increased mortality and morbidity are expected when atrial fibrillation is left untreated in patients undergoing mitral valve surgery. Modern surgical ablations resulted in a shift from the cut and sew maze procedure to the vast majority of cases being performed using different ablation technologies. The use of ablation technology simplifies the procedure. The expectation is that the vast majority of patients with atrial fibrillation will be ablated at the time of their mitral valve surgery.

Summary: Patients who have mitral valve with or without tricuspid valve disease with a significant history of atrial fibrillation may benefit from surgical ablation to eliminate atrial fibrillation. No increased perioperative morbidity or mortality has been documented with an improved long-term survival and very low incidence of thromboembolic events.