Surgical perspectives in the management of atrial fibrillation

Table 3 Adapted from 2012 Heart Rhythm Society/European Heart Rhythm Association/European Society of Cardiology guidelines

Indications for concomitant surgical ablation of AF
Symptomatic AF refractory or intolerant to at least one Class 1 or 3 antiarrhythmic medication
Paroxysmal: Surgical ablation is reasonable for patients undergoing surgery for other indications (IIa, C)
Persistent: Surgical ablation is reasonable for patients undergoing surgery for other indications (IIa, C)
Longstanding persistent: Surgical ablation is reasonable for patients undergoing surgery for other indications (IIa, C)
Symptomatic AF prior to initiation of antiarrhythmic drug therapy with a Class 1 or 3 antiarrhythmic agent
Paroxysmal: Surgical ablation is reasonable for patients undergoing surgery for other indications (IIa, C)
Persistent: Surgical ablation is reasonable for patients undergoing surgery for other indications (IIa, C)
Longstanding persistent: Surgical ablation may be considered for patients undergoing surgery for other indications (IIb, C)
Indications for standing alone surgical ablation of AF
Symptomatic AF refractory or intolerant to at least one Class 1 or 3 antiarrhythmic medication
Paroxysmal: Stand alone surgical ablation may be considered for patients who have not failed catheter ablation but prefer a surgical approach (IIb, C)
Paroxysmal: Stand alone surgical ablation may be considered for patients who have failed one or more attempts at catheter ablation (IIb, C)
Persistent: Stand alone surgical ablation may be considered for patients who have not failed catheter ablation but prefer a surgical approach (IIb, C)
Persistent: Stand alone surgical ablation may be considered for patients who have failed one or more attempts at catheter ablation (IIb, C)
Longstanding persistent: Stand alone surgical ablation may be considered for patients who have not failed catheter ablation but prefer a surgical approach (IIb, C)
Longstanding persistent: Stand alone surgical ablation may be considered for patients who have failed one or more attempts at catheter ablation (IIb, C)
Symptomatic AF prior to initiation of antiarrhythmic drug therapy with a Class 1 or 3 antiarrhythmic agent
Paroxysmal: Stand alone surgical ablation is not recommended (III, C)
Persistent: Stand alone surgical ablation is not recommended (III, C)
Longstanding persistent: Stand alone surgical ablation is not recommended (III, C)

AF: Atrial fibrillation.