title: The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation.
abstract: 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. (Class I, Level A) Surgical ablation for AF can be performed without additional operative risk of mortality or major morbidity, and is recommended at the time of concomitant isolated aortic valve replacement, isolated coronary artery bypass graft surgery, and aortic valve replacement plus coronary artery bypass graft operations to restore sinus rhythm. (Class I, Level B nonrandomized) Surgical ablation for symptomatic AF in the absence of structural heart disease that is refractory to class I/III antiarrhythmic drugs or catheter-based therapy or both is reasonable as a primary stand-alone procedure, to restore sinus rhythm. (Class IIA, Level B randomized) Surgical ablation for symptomatic persistent or longstanding persistent AF in the absence of structural heart disease is reasonable, as a stand-alone procedure using the Cox-Maze III/IV lesion set compared with pulmonary vein isolation alone. (Class IIA, Level B nonrandomized) Surgical ablation for symptomatic AF in the setting of left atrial enlargement (≥4.5 cm) or more than moderate mitral regurgitation by pulmonary vein isolation alone is not recommended. (Class III no benefit, Level C expert opinion) It is reasonable to perform left atrial appendage excision or exclusion in conjunction with surgical ablation for AF for longitudinal thromboembolic morbidity prevention. (Class IIA, Level C limited data) At the time of concomitant cardiac operations in patients with AF, it is reasonable to surgically manage the left atrial appendage for longitudinal thromboembolic morbidity prevention. (Class IIA, Level C expert opinion) In the treatment of AF, multidisciplinary heart team assessment, treatment planning, and long-term follow-up can be useful and beneficial to optimize patient outcomes. (Class I, Level C expert opinion).
authors.affiliation: Division of Cardiothoracic Surgery, West Virginia University, Morgantown, West Virginia. Electronic address: vinay.badhwar@wvumedicine.org.
authors.forename: Vinay
authors.initials: V
authors.lastname: Badhwar
authors.affiliation: Division of Cardiothoracic Surgery, West Virginia University, Morgantown, West Virginia.
authors.forename: J Scott
authors.initials: JS
authors.lastname: Rankin
authors.affiliation: Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri.
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Damiano
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: A Marc
authors.initials: AM
authors.lastname: Gillinov
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Faisal G
authors.initials: FG
authors.lastname: Bakaeen
authors.affiliation: Department of Cardiothoracic Surgery, Baylor Plano Heart Hospital, Plano, Texas.
authors.forename: James R
authors.initials: JR
authors.lastname: Edgerton
authors.affiliation: Department of Cardiothoracic Surgery, Sentara Heart Hospital, Norfolk, Virginia.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Philpott
authors.affiliation: Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: McCarthy
authors.affiliation: Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Steven F
authors.initials: SF
authors.lastname: Bolling
authors.affiliation: Department of Cardiovascular Services, Florida Heart and Vascular Care at Aventura, Aventura, Florida.
authors.forename: Harold G
authors.initials: HG
authors.lastname: Roberts
authors.affiliation: Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia.
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.affiliation: Division of Cardiothoracic Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Shemin
authors.affiliation: The Society of Thoracic Surgeons, Chicago, Illinois.
authors.forename: Scott
authors.initials: S
authors.lastname: Firestone
authors.affiliation: Division of Cardiothoracic Surgery, West Virginia University, Morgantown, West Virginia.
authors.forename: Niv
authors.initials: N
authors.lastname: Ad
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000592:standards*; D006801:Humans; D017410:Practice Guidelines as Topic; D012955:Societies, Medical; D013903:Thoracic Surgery; D014481:United States