Possibilities and prospects of surgical treatment of atrial fibrillation
The surgical treatment of patients with atrial fibrillation is of great scientific and practical interest for modern cardiac surgeons. More than 25 years have passed since the first successful atrial fibrillation elimination surgery. During this time the daily practice has accumulated some experience of the surgical treatment of patients with this arrhythmia and the attempts to investigate the electrophysiological substrate of its source and maintenance were made. Today possible causes of atrial fibrillation are already known, schemes of this disease prevention and methods of its surgical correction are defined. The problem is the variety of mechanisms of this arrhythmia and practical impossibility of its accurate identifying for each patient. Lately there has been a trend of improving the treatment results of patients with this pathology due to the improvement of electrophysiological diagnosis complex, methods of surgical treatment, cardiopulmonary bypass, anesthesia and intensive care benefits, as well as the emergence of new ablation technologies capable to replace surgical incisions. The worldwide practice shows that the application of this approach for patients with planned cardiac surgery intervention, in the absence of contraindications, along with the restoration of sinus rhythm, may help to reduce hospital mortality, improve the life quality of patients and increase the life expectancy at later dates. It was also noted that such criteria as the ability of the operation to ensure freedom from atrial fibrillation for a long time, the influence on the functional state of sinus node, the elimination of causes of early and late returns of atrial arrhythmias, the absence of thromboembolic complications and the restoration of the mechanical function of the atria are also of great importance for evaluation and further selection of a procedure for the surgical treatment of atrial fibrillation. The outstanding challenge of the atrial fibrillation treatment remains primarily issues of tactics and proper selection of patients for the surgical treatment. Nowadays to eliminate the atrial fibrillation in cardiac surgery there are different types of surgical procedures requiring the usage of alternative sources of energy to create transmural atrial damage following the concept of Cox Maze III procedure. Nevertheless, some surgical treatments that are described in the medical literature are based on the limited experience and technical feasibility but not on the true science.