Atrial Fibrillation
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Nicolas Doll, EHRA 2023: The history of atrial fibrillation surgery and the unmet needs of patients with long standing persistent atrial fibrillation

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Published Online: May 18th 2023

Complex 3D mappings indicated a need for an endocardial and epicardial approach to treat patients with a long standing persistent form of atrial fibrillation. In this touchCARDIO interview, we speak with Dr Nicolas Doll (Schuechtermann-Clinic, Bad Rothenfelde, Germany) to discuss the history of atrial fibrillation surgery and the unmet needs for these patients.

Nicolas Doll presented an abstract entitled ‘CEASE AF: Primary Efficacy and Safety Endpoints’ at the European Heart Rhythm Association congress, 16–18, April 2023.

Click here to view the CEASE AF discussion.


  1. Can you give a brief overview of the history of atrial fibrillation surgery and the development of interventional ablation? (0:20)
  2. What are the unmet needs in the treatment of atrial fibrillation? (2:25)

Disclosures: Nicolas Doll is a consultant for Atricure and NeoChord, is on the advisory board for Medtronic, and has received honoraria from Atricure, NeoChord and Medtronic.

Support: Interview and filming supported by Touch Medical Media. Interview conducted by Danielle Crosby.

Filmed as a highlight of EHRA 2023

Access more content on atrial fibrillation here



My name is Nicolas Doll. I’m a cardiac surgeon. I’m head of the Department at the Schuechtermann-Clinic, Bad Rothenfelde, it’s located in between Hanover and Hamburg in Germany. 

Q. Can you brief an overview of the history of atrial fibrillation surgery and the development of interventional ablation?

Now everything began more than 35 years ago when a cardiac surgeon and his EP at that time made intraoperatively epicardial mapping exams and they found out how to treat effectively, surgically  atrial fibrillation. And they designed the so-called Cox-maze IV surgery that was very invasive surgery with the need of the extracorporeal circulation and the cardiac arrest time of more than one hour. And with time and technological advancements, atrial fibrillation was treated very effectively with catheter techniques, and surgery was too invasive. 

Meanwhile, it is quite clear that the paroxysmal, that is a kind of benign form of atrial fibrillation, is treated with excellent results by electrophysiologists. But the huge population worldwide suffer from long standing, persistent, and this is a kind of advanced atrial fibrillation. These patients have an enlarged left atrium. They have a high amount of fibrosis. It is quite challenging to treat them with a catheter. We know that the success rate after one procedure is around 30%. Also with the surgical approach, which changes meanwhile to a minimally invasive epicardial approach is also on its own, not effective enough. So that was the background to think about how we can bring cardiac surgeons and electrophysiologists together in order to collaborate to improve the outcomes in the treatment of this advanced form of atrial fibrillation. 

Q. What are the unmet needs in the treatment of atrial fibrillation?

The idea was, that is also part of the background, that we found out due to complex 3D mappings that the advanced form of atrial fibrillation has different epicardial and endocardial signals. So there is a kind of dissociation between the epicardium and the endocardium, and that was the background for the need for an endocardial and epicardial approach to treat effectively a long standing persistent atrial fibrillation.

Subtitles and transcript are autogenerated

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