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Background – The Cox Maze procedure for treatment of medically refractory atrial fibrillation (AF) is limited by its complexity and requirement for cardiopulmonary bypass. Long-term follow-up and success using criteria established by the HRS/EHRA/ECAS consensus statement have not been reported for surgical AF ablation. We describe the results of using a thorascopic approach and radiofrequency energy to perform bilateral pulmonary vein isolation (PVI) and left atrial (LA) ganglionic plexi (GP) ablation for treatment of AF. Methods and Results- Forty-five (33 – paroxysmal; 12 – persistent) consecutive patients underwent thorascopic bilateral radiofrequency PVI, GP ablation, Ligament of Marshall ablation, and left atrial appendage (LAA) exclusion by a single surgeon. Forty-three patients were prospectively followed without antiarrhythmic drugs (AAD) for a minimum of 1 year with a 30-day continuous event monitor or pacemaker interrogation at 6 and 12 mos. Failure was defined as any atrial tachyarrhythmia (AT) of> 30 seconds duration occurring more than 90 days after surgery. Mean follow-up was 516 +/- 181 days (202