Surgical treatment of atrial fibrillation during coronary artery bypass grafting

Abstract

An analysis of contemporary literature demonstrates that atrial fibrillation (AF) significantly worsens the course of ischemic heart disease and adversely affects prognosis in patients undergoing coronary artery bypass grafting (CABG), increasing the risk of thromboembolic events, heart failure, and mortality. In this context, the strategy of concomitant surgical correction of AF during CABG has gained particular importance. The most commonly employed techniques include pulmonary vein isolation and various modifications of the Maze procedure, particularly the Cox Maze IV, which allow effective targeting of the arrhythmogenic substrate within a single intervention. Clinical studies indicate that the addition of ablation to CABG significantly increases the rate of sinus rhythm maintenance, improves patients’ quality of life, and is associated with a reduced risk of stroke and improved long-term survival. The extent of ablation is determined by the form of AF, duration of arrhythmia, and structural cardiac changes: pulmonary vein isolation is often sufficient in patients with paroxysmal AF, whereas more extensive lesion sets, such as the Maze procedure, are preferred in persistent forms. Despite concerns regarding a potential increase in operative risk, accumulated evidence supports the clinical validity of this approach when appropriate patient selection is ensured. Thus, the present review is aimed at analyzing contemporary surgical strategies for the treatment of AF in patients undergoing CABG, with an assessment of their efficacy, safety, and impact on clinical outcomes.