Surgical ablation for atrial fibrillation: an editorial

AF is the most common cardiac arrhythmias in background of cardiovascular structural disease as well as postoperative arrhythmic complication. Based on the international guidelines of American College of Cardiology and European Society of Cardiology, this phenomenon can be distinguished as one of the three classes including paroxysmal AF that terminates within 7 days of appearance, persistent AF that prolongs more than 7 days and can be terminated by pharmacological and non-pharmacological interventions, and permanent AF that is persisted for a long time (1). The appearance of every type of AF is strongly associated with underlying cardiac abnormalities including acute coronary syndrome, heart failure, valvular heart diseases, as well as some predisposing risk factors such as hypertension, diabetes, and obesity (2). Moreover, inflammatory and metabolic processes, hemodynamic stresses, respiratory disorders, drug and alcohol use, and endocrine abnormalities have been identified to promote AF (3). Furthermore, familial tendency of AF has been also well identified that parental AF is a trigger to increase likelihood of AF. Regardless of underlying etiological aspects and pathophysiological basis, the appearance of AF is related to increased risk for mortality and morbidity particularly due to risk for thromboembolic events (4). Some studies have revealed that people with sinus rhythm survive longer than those with AF. In fact, disruption of normal atrial conductive system may cause blood stasis leading development of thrombus and thus embolic events especially in cerebrovascular system results in brain stroke (5). Additionally, AF can predispose affected individuals to worsening heart failure and lowering functional class in these patients particularly in those patients with persistent hypertension or valvular defects. The progression of AF-induced heart failure finally leads to tachycardia-mediated cardiomyopathy if inadequate controlling arrhythmia (6). In some large cohort surveys, one-third of patients with uncontrolled AF suffered brain stroke or other thromboembolic events. These induced cerebrovascular events may also result in dementia, cognitive decline, and disabilities in daily living activities (7).