Advances in surgery for atrial fibrillation from cut and sew technique to thoracoscopy and new energy source have enabled minimally invasive approach which avoids median sternotomy and cardiopulmonary bypass. However, minimally invasive approach is unable to match the outcome of classic surgical technique due to difficulty in creating some of linear ablation lines. Hybrid procedure using catheter mapping and ablation in addition to minimally invasive surgical ablation has gained interest to combine the advantages of both procedures. No large study has been conducted to date comparing this new technique to other existing treatments. The aim of this paper is to review the data on hybrid procedure for atrial fibrillation and assess its early outcome and efficacy. 1. Introduction Surgical treatment for atrial fibrillation (AF) has evolved over the years. Cox-Maze operation initially performed by cut and sew technique has been highly effective in the treatment of AF [1]. With recent advances in energy source to substitute classic cut and sew technique, minimally invasive technique has emerged as new approach avoiding median sternotomy and cardiopulmonary bypass [2]. Most of these procedures perform pulmonary vein isolation (PVI) and create linear lesions utilizing video-assisted thoracoscopy (VATS). However, some linear lesions cannot be created from epicardial ablation thus limiting the efficacy of this approach [3]. Catheter ablation has also evolved as effective treatment for paroxysmal AF. Linear ablation has been one of the developing fields, using 3-dimensional navigation systems for atrial mapping. This has enabled creating a similar ablation line to surgical ones. With PVI and linear ablation, success rate for single intervention is reported to be 57 to 77% [4]. However, multiple procedures are often required and have poor success rates for persistent AF and long-standing persistent AF. Recent reports of hybrid approach which combines VATS epicardial and catheter endocardial approach, reduces each treatment’s disadvantages and achieves complete ablation for high risk patients. The purpose of this paper is to review the current data on hybrid surgical and catheter ablation for AF. 2. Technique Patients are considered for hybrid procedure in case of paroxysmal, persistent, or long-standing AF with left atrial dilatation over 4.5？cm based on current guidelines [5]. Preoperative transthoracic echocardiogram and computer tomography are obtained to assess PV and coronary anatomy. In addition, spirometry is required to assess pulmonary function and whether
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