7 Their lesion set included PVI with upper and lower pulmonary vein connecting lines, a lesion to the LAA and on the left atrial roof to the aortic valve non-coronary sinus, as well as LAA stapler exclusion. They report 90% 2-year freedom from AF and off AAD,

with no mortality and no stroke events.40 There are some caveats with regards to LAA isolation. The limitation of the right-sided thoracoscopic approach is the inability to exclude the left atrial appendage, although new devices may allow for endocardial occlusion. Also, of note, the Left Atrial Appendage Occlusion Study (LAAOS) trial revealed that Inhibitors,research,lifescience,medical a significant proportion of endocardial LAA closures Inhibitors,research,lifescience,medical using an encircling technique or a running suture as well as staple exclusion recannulated when assessed by echocardiography (55% versus 28%).41 This suggests that complete LAA amputation may be superior to suture ligation or staple exclusion. Robotic-Assisted Surgical www.selleckchem.com/products/U0126.html ablation Loulmet and colleagues first described robotic PVI using a flexible microwave probe through the left chest.42

This was extended to microwave ablation via a right mini-thoracotomy with groin cannulation on cardiopulmonary bypass.43 More recently, Cheema et al. report successful robotic argon cryoablation with femoral cannulation for completion of left-sided Inhibitors,research,lifescience,medical surgical ablation lesions and endocardial LAA exclusion.44 In summary, the field of surgical ablation for atrial fibrillation is rapidly expanding. In this paper, different energy sources currently available when performing a surgical ablation procedure for atrial fibrillation were discussed. Based on the published literature and our own Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical experience, the two most prominent energy

sources currently used are cryothermy and bipolar radiofrequency. Three surgical approaches for the performance of the atrial fibrillation ablation procedure were also discussed. Median sternotomy remains the approach most commonly used; however, the use of a minimally invasive approach is becoming more refined thus offering patients a viable alternative approach to the performance of the procedure. The use of robotic technology in performing the surgical ablation procedure is one of the newest platforms for the performance Cilengitide of the ablation procedure so was briefly discussed. CONCLUSION The surgical treatment for atrial fibrillation has changed over the past decade. Today the vast majority of the procedures are being performed using alternative energy sources to create the lesions. In the field of surgery for stand-alone atrial fibrillation a lot of beating-heart procedures are being performed, with minimal success, however, especially in patients with persistent and long-term persistent atrial fibrillation.