Table 6.

2024 Guidelines for surgical and hybrid AF ablation

Clinical scenarios	Advice/Recommendations
Concomitant surgical AF ablation is beneficial in patients with paroxysmal or persistent AF undergoing left atrial open cardiac surgery regardless of prior antiarrhythmic drug failure or intolerance	TO DO
Concomitant surgical AF ablation is beneficial in patients with paroxysmal or persistent AF intolerant or refractory to previous antiarrhythmic drug therapy, undergoing closed (non-left atrial open) cardiac surgery	TO DO
Biatrial Cox-maze procedure or a minimum of PVI plus left atrial posterior wall isolation is beneficial in patients undergoing surgical AF ablation concomitant to left atrial open cardiac surgery	TO DO
Documentation of exit and/or entrance block across pulmonary veins and completeness of deployed lines is beneficial during surgical AF ablation	TO DO
Concomitant surgical AF ablation is reasonable in patients with paroxysmal or persistent AF prior to initiation of Class I or III antiarrhythmic therapy, undergoing closed (non-left atrial open) cardiac surgery	May be appropriate TO DO
Stand-alone surgical or hybrid ablation is reasonable in symptomatic patients with persistent AF with prior unsuccessful catheter ablation as well as in those who are intolerant or refractory to antiarrhythmic drug therapy and prefer a surgical/hybrid approach, after careful consideration of relative safety and efficacy of treatment options	May be appropriate TO DO
Stand-alone surgical or hybrid ablation may be reasonable in symptomatic patients with paroxysmal AF with prior unsuccessful catheter ablations who prefer a surgical/hybrid approach, after careful consideration of relative safety and efficacy of treatment options	Area of uncertainty

AF atrial fibrillation; PVI pulmonary vein isolation

Adapted from reference 84 with permission