Atrial Fibrillation Surgery in the Era of Minimally Invasive Surgery: Biatrial Versus Left Atrial Maze

OBJECTIVE: Atrial fibrillation management is rapidly evolving, particularly for patients who are intolerant to medical therapy. Several catheter-based, surgical, and hybrid approaches currently exist, each with unique benefits that may be harnessed to provide optimal outcomes for these patients. This review focuses on the use of a biatrial lesion set versus an isolated left atrial lesion set for ablation. METHODS: Major representative articles for each ablation strategy were identified and included. Terms searched on PubMed, Google Scholar, and Scopus included "atrial fibrillation ablation," "atrial fibrillation surgery," and "maze procedure," among others. Additional articles were included based on expert opinion. RESULTS: The complete Cox maze biatrial lesion set has the highest efficacy but requires cardiopulmonary bypass. An isolated left atrial lesion set can also be performed, and these approaches are often less invasive but not as efficacious as the traditional complete maze operation. CONCLUSIONS: Although biatrial ablation may carry a higher risk of conduction abnormalities than isolated left atrial ablation in the setting of atrial fibrillation, biatrial ablation is more efficacious in maintaining sinus rhythm.