In recent years, with the continuous progress of three-dimensional marker measurement technology, the catheter ablation technique of atrial fibrillation has been gradually improved, and has been gradually popularized to the primary hospitals from the original only in the large arrhythmia centers, but because the mechanism of atrial fibrillation is still unclear, the success rate of ablation is still low, and the recurrence rate is high, especially in persistent atrial fibrillation, the success rate of one-time ablation is less than 50%, thus greatly limiting the further development of this technique. further development. How to further ‘improve the success rate of catheter ablation and reduce the recurrence rate has been a hot topic of concern for electrophysiologists. Ablation strategies for paroxysmal AF are now well defined, focusing on complete isolation of the pulmonary veins coupled with ablation of trigger foci outside the pulmonary veins, whereas for persistent AF there is no uniform ablation strategy, but regardless of the ablation strategy adopted, the results seem to be similar, i.e., ablation success rates are equally low. The latest study published in the New England Journal suggests that, with the exception of pulmonary vein isolation, adding additional ablation lines or ablating CAF?potentials does not increase additional success rates but rather increases the incidence of postoperative atrial tachycardia. There is no uniform ablation strategy, no uniform evaluation method, and regardless of the ablation method you use, the outcome remains suboptimal. The basic principle of medical catheter ablation for atrial fibrillation is to mimic the surgical maze procedure for the eradication of atrial fibrillation. The basic principle of the maze procedure is to create a pathway that allows impulses from the sinus node to reach the atrioventricular node to drive the ventricles. The procedure avoids atrial foldback, preserves atrial synchronization and postoperative atrial transmission, while eliminating the risk of thrombosis. The classic maze procedure has undergone continuous improvement from type I to type III. The procedure involves resection of the left and right auricles, making four incisions along the peripulmonary vein, the right atrial wall (from the root of the superior vena cava posteriorly to the sulcus sulcus), the atrial septum (from the top of the atrium to the fossa ovalis) and the top of the atrium between the right and left auricles (incision through the root of the superior vena cava anteriorly and around the pulmonary vein), and severing the border ridge. The labyrinth type III procedure was modified from the type I procedure in two ways: no incision was made at the top of the right atrium; and a cup-shaped incision was made around the four pulmonary vein ports. The modification reduces the extent of the surgical incision, avoids damage to the sinus node artery and reduces the extent of left atrial isolation, achieving a better time-varying heart rate response and recovery of atrial function, and less need for a permanent pacemaker. Cox et al. performed the maze procedure in 306 patients with atrial fibrillation from 1989 to 1999, with a mortality rate of 3.3% for the entire group. 265 patients completed 3 to 11.5 years of follow-up (mean 3.7 ± 2.9 years), of whom 95% had complete resolution of atrial fibrillation and another 5% were able to control atrial fibrillation with antiarrhythmic drugs without recurrence. The Wolf Mini-maze procedure was proposed by Dr. Randall Wolf in 2002 for isolated AF and paroxysmal AF. The procedure performs four key steps, including bilateral pulmonary vein isolation, linear ablation of the left atrium, partial denervation of the epicardium, and excision of the left auricle. The procedure avoids the traditional median chest opening, which is less invasive and safer; the heart beats without extracorporeal circulation, the procedure is performed under direct vision, the ablation line is clear and accurate, and complications such as pulmonary vein stenosis are avoided; and radiological damage from prolonged X-ray exposure is also avoided. Dr. Wolf reported that the cure rate of atrial fibrillation can reach 91.3% at 6 months, and the need for antiarrhythmic drugs and anticoagulants is eliminated. The overall cure rate 2 years after surgery was 80%, with no postoperative strokes. The success rate of both classical maze and minimally invasive surgical ablation is much higher than that of medical catheter ablation, and surgical experience demonstrates that the success rate of catheter ablation of persistent atrial fibrillation is inevitably low if only the pulmonary veins are isolated. So, what exactly is the reason for the low success rate of medical catheter ablation? This is a reality that we must face. First, it is difficult to achieve transmural injury at every ablation site, with the result that 80% of patients with AF recurrence find recovery of a particular pulmonary vein potential, and second, it is difficult to achieve complete bidirectional block at every ablation line and to validate bidirectional block for every ablation line in the limited time available, thus offsetting the additional effect of these additional ablation lines. Thus, catheter ablation is an inherent deficiency in persistent AF, which can be compensated by surgical ablation, and combined medical-surgical or hybrid ablation strategies have been developed.