**4. Indication for surgical atrial fibrillation ablation**

A recent consensus statement described current indications for surgical ablation of AF include


Strong evidence showing an association between AF and increased mortality and morbidity has led to recent expert consensus guidelines to recommend surgical ablation at the time of concomitant cardiac procedures to restore sinus rhythm with a Class I or IIa indication [31, 47]. Addition of concomitant surgical ablation for AF does improve health-related quality of life (HRQL) and AF-related symptom. It also improves short-term and long-term survival [31].

Some relative indications for surgery that were mentioned in AF surgery expert institutions are persistent AF patients with high risk for stroke and CHADS2 score ≥ 2 and inability to take life-long and anticoagulation and persistent AF patients with proper anticoagulation but still have had a cerebrovascular event [2].

Recent consensus guidelines recommend addition of a concomitant surgical ablation procedure for AF does not change the incidence of perioperative or late stroke/ TIA (class IIa) but subgroup analysis of nonrandomized controlled trials found a significant reduction in late stroke/TIA incidence [31].
