Surgical perspective on hybrid ablation for non-paroxysmal atrial fibrillation

Atrial fibrillation (AF), the most common cardiac arrhythmia in the world, has an increasing incidence in general population (1). According to duration of episode, AF is divided into paroxysmal AF, persistent AF and long-standing persistent AF. To avoid stroke, arterial embolism and other critical complications, convert to normal sinus rhythm as soon as possible is the best strategy for AF management. Cox-Maze III procedure, also called as “cut and sew” Maze, is still the gold standard procedure of treating AF (2). Briefly, a series of scars were made by Cox-Maze III to interrupt or isolate reentry circuits by “cut and sew” of the atrium. Though the results of 5-year follow-up were very attractive (96.6–99% of patients free of AF), Cox-Maze III was replaced gradually by more simplified Cox-Maze IV due to development of new devices of ablation energy and procedure (2).