In China, the serious threat that atrial fibrillation (AF) poses to patients’ cardiac function, health status, and quality of life has received increasing attention. According to the findings of the National Heart Lung and Blood Institute (USA) in 2005, there are now nearly 10 million patients with AF in China. According to epidemiological studies in China, paroxysmal and isolated AF (atrial fibrillation without other heart diseases) accounts for more than 1/3 of the total number of patients. According to conservative estimates, there are currently more than 3 million patients with paroxysmal and isolated AF on the mainland. In the early 20th century, radiofrequency ablation therapy was introduced and achieved good results. In 2002, Ward 9 of Beijing Anzhen Hospital started to perform radiofrequency ablation of atrial fibrillation in patients with organic atrial fibrillation (atrial fibrillation with other cardiac diseases requiring surgical treatment, such as valvular disease requiring valve replacement surgery, etc.) in conjunction with cardiac surgery. However, this effective surgical treatment for atrial fibrillation is still only available for patients with organic atrial fibrillation. The conventional median sternal incision and injury are difficult to accept for patients with isolated AF. Then catheterized atrial fibrillation radiofrequency ablation therapy appeared, providing a new treatment for these patients, but with poor single-site efficacy. It was not until 2005 that minimally invasive surgical radiofrequency ablation treatment emerged, providing a new and efficient treatment option for this group of patients.9 Ward 9 was the first to introduce this new treatment method to China in 2006. Since then 90％ of the patients treated for atrial fibrillation have been cured. After years of hard work, Ward 9 at Beijing Anzhen Hospital has become the largest surgical atrial fibrillation treatment center in Asia and one of the top 3 internationally. Director Meng Xu has also been elected by international experts as a director of the International Society for Minimally Invasive Surgery. Minimally invasive surgical atrial fibrillation treatment, internationally, is increasingly accepted by patients with isolated atrial fibrillation for its safety, efficiency, and minimal trauma. From 2007 to the present, nearly 300 patients have received minimally invasive surgical atrial fibrillation radiofrequency ablation treatment at Beijing Anzhen Hospital. The cure rate of paroxysmal isolated atrial fibrillation has reached 90％. The indication population for minimally invasive radiofrequency ablation surgery is isolated atrial fibrillation. Its main features are safety, efficiency, minimal trauma and short procedure time. Technically speaking, minimally invasive cardiac surgical ablation surgery applies a surgical ablation energy system to ablate the epicardium in the key areas of atrial fibrillation occurrence and maintenance through small incisions in the bilateral chest, assisted by thoracoscopy, without the heart beating. The main operations include four: extensive isolation of bilateral pulmonary veins; linear ablation of the left atrium; partial denervation of the epicardium; and excisional operation of the left auricle. In addition to the differences in ablation modalities, the main advantages of minimally invasive cardiac surgery techniques compared to catheter interventional ablation techniques are: 1. Treatment concept: The concept of minimally invasive surgery is to achieve the therapeutic measures needed to theoretically cure atrial fibrillation using surgical approaches with the least possible trauma, including: pulmonary vein isolation (PVI), left atrial circumferential pulmonary vein line ablation (WACA), autonomic ganglion (GPs) ablation, and severance and ablation of Marshall’s ligament, four key treatments. Among them, the severance and ablation of Marshall’s ligament can only be achieved by surgery.2 The removal of the left auricle is also the only treatment that can be achieved by surgery. The left auricle is the main site of thrombus formation in patients with atrial fibrillation. Removal of the left auricle reduces the risk of thrombosis and embolism, and the risk of thrombosis is significantly reduced even in the small number of patients treated who are not completely cured of atrial fibrillation. Minimally invasive surgical techniques routinely remove the left auricle under direct visualization, an operation that can reduce the rate of stroke due to atrial fibrillation to less than 10%; and for patients who already have a thrombus in the auricle and are therefore contraindicated for catheter ablation, minimally invasive surgery can directly remove the auricle and thrombus, eliminating the risk of stroke to a significant degree.3. Wall penetration and accuracy of the ablation line. One of the keys to the success of radiofrequency ablation therapy for atrial fibrillation is the complete and wall penetration of the ablation line isolated from the pulmonary veins. Because incomplete or impermeable ablation lines can lead to residual electrical traffic between the pulmonary veins and the left atrium, resulting in failure of atrial fibrillation treatment. This is the main reason why the classical surgical Cox-maze III procedure has been able to achieve a 95％ high cure rate. The minimally invasive surgical ablation procedure uses a clamped bipolar radiofrequency ablation system in which the pulmonary vein-left atrial migration, the epicardial fat pad, is clamped between the bipolar clamps, and then the tissue between the poles is ablated by radiofrequency energy until complete wall penetration is achieved, prompted by the system’s unique wall penetration monitoring device. Depending on the thickness of the atrial tissue, the second, third, fourth or more transmural ablations are performed to the atrial side based on the first ablation line, thus creating multiple electrical conduction blockages and isolations. It should be further emphasized that the surgical ablation line is very fine, with a width of only about 1 mm, and operates under thoracoscopic and direct vision, ablating only the tissues in the target area, almost avoiding damage to adjacent tissues and structures. 4. Single treatment has a high success rate, eliminating the need for repeated ablation. Minimally invasive surgery is a single treatment, of which, the long-term cure rate, according to the overseas experience, can reach 91.3%. In China, the experience of minimally invasive radiofrequency ablation surgery in the cardiac surgery ward 9 of Beijing Anzhen Hospital shows that since December 2006, nearly 300 patients have been treated, with a cure rate of 90%. This is comparable to the efficacy of international studies. In Beijing Anzhen Hospital, the surgical treatment of atrial fibrillation has become increasingly mature, but nationwide, the surgical treatment of atrial fibrillation is still in its infancy. For the 10 million or so patients with atrial fibrillation, this technology should and will certainly provide better treatment for atrial fibrillation patients, taking into account the existing international and domestic experience. The main advantage of minimally invasive surgery is undoubtedly the high cure rate of a single ablation. 5. Good safety and low complication rate. As mentioned above, minimally invasive surgery is performed under thoracoscopy and direct vision, using advanced ablation systems, which can completely avoid damage to atrial tissues other than the target tissues, and operates only on the pulmonary vein-left atrial migration, part of the left atrium, without the possible complications of catheter ablation such as pulmonary vein stenosis, esophageal injury, or even heart rupture; from the practical point of view According to the international experience and the early treatment results of Anzhen Hospital, there are very few complications related to ablation, and the arrhythmogenic effect of minimally invasive surgery is very low, and there are few cases of frequent postoperative atrial tachycardia and atrial prematureness. According to the statistics of Atrial Fibrillation Treatment Center of Anzhen Hospital, the average hospitalization cost is only about 60,000 RMB. Therefore, it is more suitable for the economic requirements of the majority of atrial fibrillation patients and provides a more realistic option for the treatment of atrial fibrillation. 7. No radiation damage. General catheter intervention ablation involves unavoidable X-ray radiation for both physicians and patients. In Pappone’s experience, for example, the average operating time for 267 catheter ablation patients, using the CARTO 3D calibration system, was 212 ± 60 min, of which 25 ± 10 min was spent on x-ray radiation. x-ray damage to the operator and the patient is not necessary; in contrast, this risk does not exist for minimally invasive surgical procedures. 8. As mentioned above, the characteristics of minimally invasive surgery are small trauma and low risk, which determines the short recovery period of patients after treatment, and a wide range of people can receive treatment. According to the experience of Anzhen Hospital, patients can be discharged from the hospital in 4-6 days after surgery, and the experience abroad is usually 1 to 3 days after surgery. According to international experience, the youngest patient who underwent minimally invasive surgery was 14 years old and the oldest was 87 years old; the oldest patient received at Anzhen Hospital was 73 years old and was discharged 4 days after surgery with 4 months of follow-up and no atrial fibrillation episodes. To summarize, the current indications for minimally invasive surgical ablation for atrial fibrillation are: 1, patients over 16 years of age; 2, patients with paroxysmal and isolated atrial fibrillation are the main patients, including patients with permanent atrial fibrillation who meet the relevant conditions; 3, patients with atrial fibrillation who have obvious symptoms and no serious organic heart disease, such as heart valve disease and coronary heart disease that require surgical treatment; 4, patients who are ineffective in the treatment of antiarrhythmic drugs Patients who are unable to tolerate antiarrhythmic drugs, or who cannot tolerate drug therapy; 5. Patients with left ventricular ejection fraction ≥ 30% on cardiac ultrasound; 6. Patients with contraindications to anticoagulation and antiplatelet therapy such as warfarin and aspirin; 7. Patients with heart and ear thrombosis; 8. Patients with previous history of thromboembolism, such as stroke or transient ischemic attack (TIA); 9. Patients who cannot afford catheter ablation treatment.