16. 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. 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.