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The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC

2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)

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The purpose of this study was to update the current evidence regarding the efficacy and safety of the totally thoracoscopic maze (TT-maze) procedure for the treatment of atrial fibrillation (AF). Fourteen studies published between 2011 and 2016 and comprising 1171 patients were included as follows: 545 (46%) patients had paroxysmal AF (pAF), 268 (23%) persistent AF (persAF) and 358 (31%) longstanding persistent AF (LSPAF). Fixed- and random-effect models were used to calculate the pooled overall freedom from atrial arrhythmias. The 1- and 2-year pooled overall antiarrhythmic drug (AAD) free (off-AAD) success rates were 78% (95% confidence interval (CI): 72-83%, n = 13) and 77% (95% CI: 64-86%, n = 6), respectively. The 1- and 2-year pooled on-AAD success rates were 84% (95% CI: 78-89%, n = 5) and 85% (95% CI: 78-90%, n = 3), respectively. Subanalysis regarding the different types of AF revealed a 1-year pooled off-AAD success rate of 81% (95% CI: 73-86%, n = 7) for pAF, 63% (95% CI: 57-69%, n = 5) for persAF and 67% (95% CI: 52-79%, n = 3) for LSPAF. The overall in-hospital complication rate was <3% (n = 36). We conclude that the TT-maze is an effective strategy for the treatment of AF with maintained efficacy at the 2-year follow-up. Furthermore, the TT-maze has demonstrated similar efficacy to the Cox Maze IV procedure at the midterm follow-up with a lower complication rate. Extended follow-up research is needed to determine whether the high success rates after TT-maze will be stable over time.