Study designs of evaluations included in the review
Randomised controlled trials (RCTs), historical and/or non-randomised comparative studies, case series and case reports were eligible for inclusion.
Specific interventions included in the review
Studies of intra-operative ablation using cryotherapy, radiofrequency, microwave or laser energy were eligible for inclusion. Operations involved median sternotomy with cardiopulmonary bypass performed as either a concomitant or lone procedure. Procedures using video or robotic assistance were excluded. Eligible comparator interventions were surgical treatment, including isolated surgery or the Maze-III procedure (surgical ablation), and medical management of AF. Studies of the Maze-III procedure (where the comparator was not intra-operative ablation) were also included to provide a benchmark indirect comparison.
Participants included in the review
Studies of participants aged over 18 years with AF were eligible for inclusion. Most of the participants in the included studies were middle-aged or older.
Outcomes assessed in the review
Studies were eligible if they reported on peri- and post-operative mortality or morbidity; patient factors such as operation time, length of intensive care unit stay, reoperation and readmission; outcomes related to convalescence; or costs and resource use. The primary efficacy outcome was return to normal heart rhythm (sinus rhythm).
How were decisions on the relevance of primary studies made?
Two reviewers independently assessed papers for relevance.