FORUM EKSPERTÓW
Surgical treatment of atrial fibrillation

Cardiac surgeons have always been pioneers within the field of surgery and the field of heart disease. Cardiac surgeons with their typical adventurous spirit and timeless anatomical/physiological study of the heart during the normal pursuit of their profession have a predisposed ability to develop and enhance new procedures for the heart that cannot be matched. However, through the years many cardiac interventions initially pioneered by cardiac surgeons have then been left in the hands of other specialties to develop with often increased patient risk.
Arrhythmia ablation surgery for atrial fibrillation is one such example where a very successful surgical procedure developed by Dr. James Cox in 1987 has now been left primarily in the hands of practitioners of percutaneous catheter based approaches which have lower efficacy and
a lower overall safety profile although less invasive in entry. The perceived advantage in minimally invasive percutaneous approaches has been the primary driver for referring physicians and the patient community to increase this approach almost sevenfold worldwide in just the last 5 years, whereas surgical ablation has merely doubled. The epicardial isolation of pulmonary veins has been shown to be safer and more efficacious in the long term than endocardial percutaneous catheter approaches.
However, as long as surgeons do not adapt to less invasive approaches to epicardial ablation, percutaneous ablation will still set the standard in growth. Midline sternotomies and bilateral minithoracotomies are excellent exposure incisions but not in terms of trauma to the patient and are not even comparable in comparison to a percutaneous groin catheter approach. Until surgeons are able to adapt to thoracoscopic/pericardioscopic type procedures as are sweeping the general, urologic, gynecologic, and vascular fields the referral volumes will be stationary.
Unfortunately, 15 million patients worldwide with 3 million new patients annually have or develop atrial fibrillation with the catastrophic risks of stroke, medicinal risks, and overall cardiac dysfunctional risks. These patients deserve a safe efficacious method to treat their disease process and they’re waiting for us. The percutaneous approaches are approaching their limits in therapy because of inherent limitations in the technologies available for safe, permanent percutaneous endocardial ablation. Percutaneous approaches in ablation are now stalled as...


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