Surgical Treatment of Atrial Fibrillation with Concomitant Mitral Valve Disease: An Asian Review

Atrial fibrillation (AF) is the most common sustained car-diac arrhythmia in patients with mitral valve disease and is pre-sent in up to 50 % of patients undergoing mitral valve surgery, contributing to increased risks of systemic embolization, anti-coagulant-related hemorrhage and mortality. The Cox maze III procedure, introduced in 1987 by Dr. James Cox, was the first effective operation for AF and is recognized as the gold stan-dard therapy for AF associated with organic heart disease. However, few surgeons have adopted the Cox maze III proce-dure, as it is a lengthy operation with extensive cutting, sutur-ing and blood loss. Several groups in Asia have successfully developed less invasive approaches using a number of different energy sources to create continuous lines of ablation to replace the surgical incisions. Because high-density real-time intraop-erative mapping to define the mechanisms of AF is currentl