title: Treatment of lone atrial fibrillation: a look at the past, a view of the present and a glance at the future.
abstract: Despite its proven efficacy, the Cox-Maze III procedure did not gain widespread acceptance for the treatment of lone atrial fibrillation (LAF) because of its complexity and technical difficulty. Surgical ablation for LAF can now be successfully performed utilizing minimally invasive techniques. This article provides an overview of the current state of the art in the surgical treatment of LAF. A brief review of pathophysiology, pharmacological treatment as well as catheter ablation is also provided. The most widely employed minimally invasive approach to LAF has been the video-assisted bilateral mini-thoracotomy or thoracoscopic pulmonary vein island creation and left atrial appendage removal or exclusion, usually with ganglionic plexi evaluation and destruction. Recently, a hybrid approach has been introduced, which combines a mono or bilateral epicardial approach with a percutaneous endocardial ablation in a single-step procedure to limit the shortcomings of both techniques. Suboptimal results of both catheter ablation and surgery suggest that success in the treatment of LAF will probably rely on a close collaboration between the surgeon and the electrophysiologist. Further studies are warranted to determine whether the hybrid approach is effective, especially in patients with long-standing persistent and persistent LAF.
authors.affiliation: Department of Cardiothoracic Surgery, Academic Hospital Maastricht and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands. sandro.gelsomino@libero.it
authors.forename: Sandro
authors.initials: S
authors.lastname: Gelsomino
authors.forename: Mark
authors.initials: M
authors.lastname: La Meir
authors.forename: Fabiana
authors.initials: F
authors.lastname: Lucà
authors.forename: Roberto
authors.initials: R
authors.lastname: Lorusso
authors.forename: Elena
authors.initials: E
authors.lastname: Crudeli
authors.forename: Ludovico
authors.initials: L
authors.lastname: Vasquez
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
authors.forename: Jos
authors.initials: J
authors.lastname: Maessen
mesh_terms: D020517:Atrial Appendage / Q000601:surgery; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods / Q000639:trends; D006801:Humans; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods / Q000639:trends