Recommendation 1 – Surgical AF ablation in association with cardiac surgery (2016, updated from 2010)
We suggest that a surgical AF ablation procedure should be considered in association with mitral valve, aortic valve or CABG surgery in patients with AF, when the likelihood of success is deemed to be high, the additional risk is low and sinus rhythm is expected to achieve substantial symptomatic benefit (Conditional Recommendation, Moderate Quality Evidence).

Values and preferences (2016, updated from 2010)
This recommendation recognizes that individual institutional experience and patient considerations best determine for whom the surgical procedure is performed. Importantly, the symptomatic benefit of sinus rhythm needs to be balanced with the attendant risks of ablation surgery, including the need for permanent pacing. This recommendation also recognizes that LA endocardial access is not routinely required for aortic or coronary surgery; limiting ablation to newer epicardial approaches.

Recommendation 2 – Asymptomatic lone AF, not to be considered for surgical therapy (2010)
We recommend that patients with asymptomatic lone AF, in whom AF is not expected to affect cardiac outcome, should not be considered for surgical therapy for AF (Strong Recommendation, Low Quality Evidence).

Values and preferences (2010)
This recommendation recognizes that patients with lone AF are at low risk for stroke or other adverse cardiovascular outcomes. Thus, elimination of AF in the absence of a high number of symptoms is unlikely to result in an improvement in quality of life.

Recommendation 3 – Closure of the left atrial appendage as part of surgical ablation of AF associated with cardiac surgery (2016, updated from 2010)
In patients with AF, we suggest that closure (excision or obliteration) of the LAA should be considered as part of the surgical ablation of AF associated with mitral, aortic valve or coronary artery bypass surgery if this does not increase the risk of the surgery (Conditional Recommendation, Low Quality Evidence).

Values and Preferences (2016, updated from 2010)
This recommendation places a high value on the potential for stroke reduction and a lower value on loss of atrial transport-function with LAA-closure. It places less value on the need to continue OAC even after LAA surgical excision.

Recommendation 4 – Continue OAC following surgical AF ablation per risk factors (2010)
We recommend that oral anticoagulant therapy be continued following surgical AF ablation in patients with any risks identified by the new “CCS algorithm” (Strong Recommendation, Moderate Quality Evidence).

Recommendation 5 – Continue OAC following surgical AF ablation for all MVRs (2010)
We suggest that oral anticoagulant therapy be continued following surgical AF ablation in patients who have undergone mechanical or bioprosthetic mitral valve replacement (Conditional Recommendation, Low Quality Evidence).

Values and preferences (2010)
Recommendations 6 and 7 place a high value on minimizing the risk of stroke and a lower value in the utility of long-term monitoring to document the absence of AF.