Surgical ablations, including pulmonary vein isola- tion and atrial maze at the time of valvular surgery and other open cardiac operations, have been dem- onstrated in multiple studies to reduce the recur- rence of AF.5 11 Various approaches to pulmonary vein isolation and modified left atrial, right atrial, and bi-atrial maze procedures entail longer proce- dure times, with higher risks of operative complica- tions and permanent pacemaker implantation.1 4 These adverse outcomes, coupled with the lack of large randomized trial data confirming mortality and stroke benefit, should be examined with the patient. 2. The atrial maze procedure properly refers to a specific bi-atrial lesion set performed by a cut- and-sew technique or with tissue ablation tech- nologies, including cryoenergy or radiofrequency. Of note, the term maze is often loosely applied to many variations of the original lesion set that may be less effective. When performed with com- plete encirclement of the pulmonary veins, most commonly in combination with mitral valve repair or replacement but also with aortic or tricuspid valve procedures, the maze procedure affords freedom from AF with an efficacy similar to that of catheter-based approaches.1,2,12 15 Patients undergoing combined atrial maze procedure at the time of operation for MR have a greater free- dom from recurrent AF than those who did not have a maze procedure.11 In patients with recur- rent AF who are to undergo surgical correction of MR, catheter ablation is best deferred in favor of a concomitant surgical maze, thereby avoiding the potential complications of a catheter maze and a second procedure for the patient. 3. 