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In patients who present in AF there are two strategies that could be employed.
a. DC cardioversion can be performed and the ablation can be carried out
as above.
b. Ablation can commence in AF as described above with the addition of
more ablation targets such as the atrial septum, the mitral annulus, and
inside the coronary sinus. This strategy can result in conversion to sinus
rhythm, more organized AF, or atypical AFL. AFL can then be mapped
and ablated. If, however, the patient continues to be in AF or atypical
AFL even after extensive mapping and ablation, DC cardioversion is
performed

Totally Thoracoscopic Epicardial Radiofrequency Ablation

N.B: Video opens in a new window