This article reviews the fundamentals of surgical treatment of atrial fibrillation. The clinical classification, pathophysiology, medical treatment strategy, and catheter-based interventions are also included. The Cox-Maze III procedure was developed over based on experiences of several operations which proceeded it. The operation is complex but results are excellent with over 90% of patients in normal sinus rhythm or regular atrial rhythm. Several modifications have been devised using various energies to ablate atrial myocardium as a means of extending surgical incisions to simplify the Maze III operation. Techniques and results of these operations are reviewed. Modified operations offering about 80% restoration of sinus rhythm are attractive to more surgeons because of the reduced complexity and time of operation.
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