Atrial fibrillation (AF for short) has been known for a long time. As one of the most common arrhythmia diseases, thromboembolic complications, impaired cardiac function and ventricular rhythm/rate disorders are its main hazards. Relevant epidemiological surveys have shown that the prevalence of atrial fibrillation in China is 1.83% in men and 1.92% in women over 60 years of age. Thus, it is estimated that there are about 8 million patients with atrial fibrillation in China. At present, surgery is much better than drugs in the treatment of atrial fibrillation, especially persistent and complex atrial fibrillation. In terms of surgical treatment of atrial fibrillation, minimally invasive and catheter ablation have been developed in parallel and continuously, and each has played a very important role in the treatment of atrial fibrillation. However, in terms of overall treatment outcome, the success rate of minimally invasive single ablation for atrial fibrillation is up to 90% or more, much higher than the success rate of catheter ablation of about 50%. There is still no single technique that achieves a 100% success rate for the treatment of persistent, complex atrial fibrillation. Minimally invasive ablation from the epicardium and catheter ablation from the endocardium. Both techniques have their own strengths and weaknesses. The success rate of surgical treatment of persistent and complex atrial fibrillation will be greatly improved if the advantages of these two techniques are combined and the epicardium and endocardium are ablated, which will bring more benefits to patients. In this paper, the authors have successfully applied these two techniques to the treatment of persistent and complex atrial fibrillation through years of clinical practice, and have achieved promising results. The hybrid technique, called “minimally invasive surgery + catheter”, can be described as a unique technique. In order to let more patients have a better understanding of atrial fibrillation treatment and know the difference of its treatment, this edition is introduced in the form of scientific knowledge. I. Catheter Ablation Technique Catheter ablation technique is performed through percutaneous puncture in the endocardium to isolate the pulmonary veins and left atrium for ablation. With the continuous progress of catheter three-dimensional labeling technology, the catheter ablation technology for atrial fibrillation has been gradually improved, but due to the limitations of catheter ablation itself, the success rate of ablation is still low and the recurrence rate is high, especially for persistent atrial fibrillation, the success rate of one-time ablation is less than 30%, and the success rate after multiple ablations is about 50%. International reports show that 6 years after single catheter ablation, the success rate is 23%, including 36% for paroxysmal atrial fibrillation and 15% for persistent atrial fibrillation. So, what exactly is the reason for the low success rate of catheter ablation? This is the reality we must face. First, endocardial radiofrequency ablation is difficult to achieve transmural injury at every ablation site. The results show that 80% of patients with atrial fibrillation recurrence are found to have potential recovery at the pulmonary veins; secondly, a large and complete ablation line cannot be completed during catheter ablation. Because the ablation line is achieved by ablation of points, it is difficult to achieve a complete bidirectional block by accurately connecting each ablation point from a line; again, catheter ablation cannot effectively deal with the left auricle, the culprit of thromboembolic complications in patients with atrial fibrillation. If atrial fibrillation recurs after catheter ablation, the patient will not benefit from catheter ablation at all and will still be at risk of thrombosis and will continue to take anticoagulants, etc. Finally, Marshall’s ligament and autonomic ganglion are both important triggers of atrial fibrillation, and the inability of catheter ablation to deal with the epicardial autonomic ganglion and Marshall’s ligament also affects the outcome of the procedure. The disadvantages of catheter ablation are poor continuity and wall penetration of the ablation line, low single cure rate, high percentage of patients with repeat treatment, and receiving high dose of X-ray. Its advantages are that it is less invasive, can perform detailed endocardial electrophysiological markings, and can perform local ablation of the mitral valve and tricuspid buccal valve. In recent years, with the continuous improvement of minimally invasive surgical methods and the increasing improvement of atrial fibrillation ablation devices, the minimally invasive surgical treatment techniques for atrial fibrillation have been improved and the therapeutic effect has been continuously improved. 1987, Cox designed the classic Cox maze procedure according to the mechanism of atrial fibrillation, which, despite the complexity of the procedure, ensures normal conduction of sinus excitation and avoids the folding back of the excited atria. This procedure, despite its complexity, ensured normal conduction of sinus excitation, avoided atrial folding, successfully restored atrioventricular synchronization and sinus rhythm, while eliminating the risk of thrombosis and reducing the incidence of distant strokes, with excellent results. Subsequently, cardiac surgeons around the world have made several modifications to the traditional Cox maze procedure, with less trauma and lower risk, while ensuring essentially equivalent treatment results. At the same time, along with the emergence of new ablation devices, ablation energy and ablation strategies, the treatment of atrial fibrillation through minimally invasive surgery has become a new option. In 2005, Wolf first applied the maze procedure to the field of minimally invasive cardiac surgery and reported good results with pulmonary vein isolation and left olecranon resection through small bilateral chest wall incisions. Due to the high safety and efficacy of thoracoscopic-assisted and total thoracoscopic radiofrequency ablation of atrial fibrillation, it has become an important procedure for the treatment of atrial fibrillation so far. However, this technique requires bilateral thoracotomy, which is more traumatic; in addition, this technique can only make the ablation connection between the pulmonary veins on both sides, so the surgical effect has some limitations. In this regard, we creatively designed an all-thoracoscopic left thoracic pathway ultra-minimally invasive surgery for atrial fibrillation based on the principle of classical Cox’s maze surgery. Bilateral pulmonary vein isolation, linear ablation of the left atrium, left auricular resection, Marshall’s ligament dissection, and partial denervation of the epicardium can be accomplished by operating only in the unilateral thoracic cavity. This is a new, safe and efficient treatment for dealing with atrial fibrillation, and the procedure is perfectly designed. The procedure effectively changes the status quo of poor results of catheter ablation for large atria, and provides intuitive and targeted treatment for special parts and structures of the heart (such as the left auricular region and autonomic plexus), with the advantages of high single cure rate, less trauma, continuous ablation line, and good wall penetration; at the same time, the procedure can ablate the epicardial autonomic ganglion and Marshall’s ligament, and resect the left auricle. This procedure significantly improves the ablation effect. It has opened up a new and effective treatment pathway for patients with complex atrial fibrillation, especially for patients with atrial fibrillation after catheter ablation failure. For patients with postoperative recurrence, since the left heart ear is removed intraoperatively and the origin of the left atrial thrombus is cleared, they should not continue to take anticoagulant drugs either, reducing the associated inconvenience of life and drug complications. However, minimally invasive surgical procedures for atrial fibrillation still have shortcomings. For example, due to the anatomical structure and the characteristics of minimally invasive surgical ablation procedures, it is not possible to effectively ablate the mitral and tricuspid isthmus to completely eliminate the occurrence of sinus tachycardia and atrial flutter after surgery. After understanding the advantages and disadvantages of catheter ablation and minimally invasive surgery, it is easy to find that catheter ablation has an inherent deficiency for persistent atrial fibrillation, but this deficiency can be achieved by surgical ablation, and the minimally invasive surgical technique has a very high surgical cure rate. Unfortunately, a single procedure is still not enough. Unfortunately, a single procedure still cannot achieve a 100% success rate. Therefore, if minimally invasive surgical techniques and catheter ablation techniques can be effectively combined to complement each other, the treatment of atrial fibrillation may achieve a “1+1>2” effect. It is with this concept in mind that the “hybrid” surgical strategy of minimally invasive surgery with catheter ablation was developed. Atrial fibrillation “hybrid” surgery is defined as a patient receiving epicardial (minimally invasive surgery) + endocardial (catheter ablation) atrial fibrillation ablation treatment. The procedures can be performed either simultaneously or sequentially over a period of time. The “hybrid” procedure expands the indications for radiofrequency ablation of atrial fibrillation in a complementary manner and greatly increases the success rate of a single procedure, making the success rate of single procedure ablation for atrial fibrillation close to 100%, which is the highest level in the field of atrial fibrillation treatment. This procedure is a milestone in the treatment of atrial fibrillation, as it allows multidisciplinary and multi-skilled specialists to work closely together to terminate atrial fibrillation on the operating table. The advantages of the minimally invasive surgical/catheter “hybrid” ablation technique for the treatment of atrial fibrillation are: 1. the damage caused by the precise ablation line, which is a decisive factor in the success rate of atrial fibrillation treatment, is mainly performed by minimally invasive surgery; 2. the left olecranon resection, which fundamentally eliminates the risk of thrombus formation due to atrial fibrillation, is also performed by minimally invasive surgery; 3. Ablation of the epicardial vagal ganglion and Marshall’s ligament to maximize the “soil” for AF maintenance, also performed by minimally invasive surgery; 4. Electrophysiological markers from the endocardium to verify the ablation effect of all ablation lines and to add some ablation points and lines if necessary, especially for mitral valve, tricuspid isthmus and border crest that cannot be done by minimally invasive surgery. The ablation of the mitral valve, tricuspid isthmus and border crest, which cannot be done by minimally invasive surgery, is done by catheter ablation. Minimally invasive surgical/catheter “hybrid” ablation technique basically completes all the currently accepted ablation and treatment elements in the field of atrial fibrillation treatment, and is therefore the procedure with the highest success rate to date. The minimally invasive surgical/catheter “hybrid” ablation technique requires a high level of skill from the entire medical team. It requires a highly skilled atrial fibrillation surgeon to work closely with a top-notch electrophysiologist in catheterization in order to maximize results. Different scholars have different views on the selection of the surgical sequence. At present, the mainstream of international academia recommends minimally invasive surgery first, followed by catheter ablation. This is because 1. the overall success rate of minimally invasive surgery is high, and almost all ablation lines and lesions in the left atrium can be completed intraoperatively with complete ablation and good wall penetration; 2. catheter ablation after minimally invasive surgery can be further marked to verify the integrity of the ablation lines and to mark other possible excitable foci, and to complete partial ablation lines, such as the ablation of the mitral and tricuspid isthmus lines. In the selection of surgical indications, we recommend the following patients to prefer the “hybrid” surgical approach: 1) complicated persistent atrial fibrillation, especially those with long duration (long-range persistent atrial fibrillation) and significant enlargement of the left atrium, who are expected to have poor results from simple minimally invasive surgery or catheter ablation; 2) those who have failed in previous catheter ablation; 3) those who have relapsed after atrial fibrillation surgical ablation. Those who have relapsed after ablation.