Atrial fibrillation is the most frequent arrhythmia complicating organic heart disease such as valvular disease or congenital heart disease. Currently, the use of radiofrequency ablation in combination with surgical treatment of atrial fibrillation in the setting of organic heart disease is widely accepted. However, the choice of ablation modality remains controversial, and a comparative study by Soni LK et al. found that biventricular ablation did not improve the outcome of AF compared with left atrial ablation alone, but rather increased the risk of the procedure and increased postoperative mortality (P > 0.05). In contrast, Kim JB et al. used radiofrequency ablation of surgical atrial fibrillation to treat 284 cases of mitral valve lesions combined with atrial fibrillation, including 85 cases of simple left atrial ablation and 199 cases of bilateral atrial ablation, and found that, compared with simple left atrial ablation, dual atrial ablation not only did not increase the risk of postoperative complications, but also significantly promoted the conversion or maintenance of sinus rhythm in patients with atrial fibrillation (P=0.005 ). Studies have shown that a large regression around the tricuspid annulus-inferior vena cava is the basis of atrial flutter episodes, and ablation of the right atrium, especially the tricuspid isthmus, may help to eliminate postoperative atrial flutter episodes. Therefore, in patients with left heart lesions combined with atrial fibrillation, we believe that biventricular ablation is more effective than left atrial ablation alone in restoring and maintaining sinus rhythm without increasing the risk of the procedure. However, both data sets are comparative studies of left-sided lesions combined with atrial fibrillation, and comparative studies of right-sided lesions combined with atrial fibrillation are still less reported. In adults, atrial septal defects can lead to different degrees of enlargement of the left and right atria due to the presence of prolonged shunts, which are often complicated by atrial tachyarrhythmias, especially atrial fibrillation. In the past, some scholars advocated the use of simple right atrial maze surgery, believing that simple right atrial maze surgery could not only reduce its recurrence rate of postoperative atrial fibrillation, but also avoid the impact on cardiac function and the risk of bleeding from the posterior left atrial wall after left atrial surgery. However, related studies have found that structural and electrical remodeling of the left atrial myocardium and alterations in the left atrial stroma underlie the pathogenesis of AF and are closely related to the development and maintenance of AF. Therefore, right atrial ablation alone may have potential drawbacks, while bilateral atrial labyrinth ablation may have more definite therapeutic effects. In our case, 47 adult patients with atrial defect combined with atrial fibrillation in precordial disease, 28 in the bilateral atrial ablation group and 19 in the simple right atrial ablation group, were compared and analyzed for the therapeutic effect of postoperative atrial fibrillation in both groups. The sinus rhythm maintenance rate (100%) was significantly higher in the dual atrial ablation group than in the simple right atrial ablation group (78.9%) at discharge (P=0.045); further follow-up results showed that the sinus rhythm maintenance rate (89.3%) was still significantly higher in the dual atrial ablation group than in the simple right atrial ablation group (47.4%) (P=0.002); the cumulative sinus rhythm maintenance rate at 2 years after surgery was 87.7±6.7% in the dual atrial ablation group, which was also significantly higher than that in the simple right atrial ablation group. 6.7%, which was also significantly higher than the 47.4±11.5% in the right atrial ablation-only group (P=0.003). Therefore, we believe that right atrial ablation alone has a limited and less durable effect on the elimination of atrial fibrillation than biventricular ablation, which is more effective in restoring and maintaining stable sinus rhythm in adult patients with atrial defects combined with atrial fibrillation. During AF surgery, we routinely apply bipolar RF ablation forceps to perform isolated ablation of circumferential pulmonary veins and ablation of left and right atrial tissue. Compared with the conventional Cox maze III procedure, radiofrequency ablation uses alternating current to transfer energy to atrial tissue, which can effectively replace the traditional “cut and sew” to establish atrial tissue injury, effectively simplifying the procedure and reducing the risk of postoperative atrial incisional bleeding. In addition, compared with the unipolar ablation pen, the bipolar ablation forceps can help to reduce the damage to the surrounding tissues and can more effectively ensure the wall penetration and integrity of the ablation line, thus enhancing the treatment effect of atrial fibrillation. The results of our study showed that although the extracorporeal circulation time, aortic block time and postoperative hospital stay were prolonged in bipolar ablation compared with right atrial ablation alone, there was no significant difference in the postoperative recovery and complications between the two groups, and the addition of left atrial ablation did not increase the surgical risk or the occurrence of postoperative complications in patients. Early after ablation, in order to reduce the postoperative atrial arrhythmia episodes, we routinely pumped amiodarone intravenously (30-100 mg/h) early after surgery and gave amiodarone 200 mg/d for one month after extubation (if the heart rate < 70< span=""> beats/min, the drug was suspended), which achieved better therapeutic results. To prevent postoperative intracardiac thrombosis, the heart ear tissue was routinely excised intraoperatively, and warfarin anticoagulation was given early postoperatively for three months for maintenance treatment (six months for those with intraoperative application of a human-made ring), and INR was controlled at 2.0~3.0; patients with recurrent atrial fibrillation were continued with warfarin anticoagulation. No thrombosis-related complications occurred in the whole group at a follow-up of 3 to 75 months. In addition, in some adult patients with atrial septal defect, prolonged volume overload of the left and right atria can cause enlargement of the left and right atrioventricular annulus, resulting in varying degrees of functional mitral or tricuspid valve closure insufficiency. For patients with preoperative mitral or tricuspid valve insufficiency of mild to moderate degree, we routinely perform intraoperative valvuloplasty (with the addition of a human-induced annulus if moderate insufficiency exists), and intraoperative transesophageal ultrasonography shows that all patients have good mitral and tricuspid valve closure after cardioversion, and all have no or mild regurgitation. However, the need for intraoperative valvuloplasty in patients with an enlarged preoperative annulus and only mild valvular insufficiency is still inconclusive. In this group of cases, 2 patients had mild mitral valve insufficiency before surgery, which was not treated intraoperatively, and had moderate to mild mitral valve insufficiency at follow-up, which may be due to increased left heart volume load after atrial defect closure, resulting in increased mitral regurgitation; 4 patients had mild tricuspid valve insufficiency before surgery, which was not treated intraoperatively, and had moderate tricuspid valve insufficiency and mild to moderate valve insufficiency at follow-up. It was considered that this might be due to the aggravation of functional tricuspid regurgitation. Therefore, we believe that for preoperative valves with mild-to-moderate insufficiency, intraoperative correction of the combined valvular lesions should be actively performed in conjunction with TEE findings, and a shaped ring should be added for those with moderate or greater insufficiency. For those with mild preoperative insufficiency, intraoperative TEE and exploratory findings, if there are problems with leaflet quality or annular enlargement, valvuloplasty may be performed to prevent increased volume load or annular enlargement that may aggravate valve regurgitation. In conclusion, we believe that for atrial fibrillation combined with atrial septal defect in adults with precordial disease, biventricular ablation has better therapeutic effect than right atrial ablation alone, and does not increase the risk of the procedure.