**Abstract**

Atrial fibrillation (AF) is the most common cardiac arrhythmia and is the major cause of stroke and heart failure. The treatment options of AF include medical treatment and catheter-based or surgical ablation. Cox et al. introduced the Cox-Maze procedure (the cut-and-sew Maze) that was first performed clinically in 1987 at Barnes Jewish Hospital, St. Louis, MO. This procedure is characterized by multiple incisions created at both left and right atria to terminate AF while allowing the electrical impulse generated from sinoatrial node to atrioventricular node. The Cox-Maze IV is the latest iteration developed by Damiano Jr. et al., which replaced the previous cut-and-sew Maze with a combination of less invasive linear lesions achieved by new ablation technology, the bipolar radiofrequency (RF), and cryoablation. This chapter describes the operative techniques, preoperative planning, indication for surgery, and future option of surgical treatment.

**Keywords:** atrial fibrillation, Cox-Maze, surgical ablation, cardiac surgery
