The rationale of surgical pulmonary vein isolation for treatment of atrial fibrillation.

With the development of less invasive surgical approaches and new ablation techniques, surgical treatment of atrial fibrillation has gained increasing interest over the past decade. Contrary to the complex Maze procedure, new less laborious approaches with pulmonary vein isolation as the main focus are within the reach of most cardiothoracic surgeons. However, although important new pathophysiological mechanisms have emerged in recent years due to extensive basic and clinical research, several uncertainties and hurdles concerning this treatment modality remain. This article reviews the rationale of surgical pulmonary vein isolation, based on these increased insights. Furthermore, important technical aspects including the possible advantages of an epicardial approach, the optimal left-sided lesion set and the need for transmurality are discussed in depth.