Atrial fibrillation (AF) is the most common atrial arrhythmia but it is
not a benign disease. AF is an important risk factor for thromboembolic
events, causing significant morbidity and mortality. The left atrial
appendage (LAA) plays an important role in thrombus formation but the
ideal way to manage the LAA is still debated. The increasing popularity
of surgical epicardial ablation and hybrid endo-epicardial ablation
approaches, especially in patients with a more advanced diseased
substrate, has raised the interest in epicardial LAA management.
Minimally invasive treatment options for the LAA offer a unique
opportunity to close the LAA with a clip device. This review highlights
morphologic, electrophysiologic and surgical aspects of the left atrial
appendage with regard to atrial fibrillation surgery, and aims to
illustrate the different surgical management strategies.