For cardiac surgery patients presenting with atrial fibrillation (AF), surgeons offer an operation that corrects the structural heart disease and the AF. With this approach, it is estimated that surgeons will perform more than 10,000 ablation procedures in 2008. Surgeons are developing minimally invasive techniques for stand-alone, epicardial ablation of AF. This article reviews the rationale for surgical ablation of AF, describes the classic maze procedure and its results, details new approaches to surgical ablation of AF, emphasizes the importance of management of the left atrial appendage, and considers challenges and future directions in the ablation of AF.
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