Treatment of Atrial Fibrillation by Minimal Invasive Surgery

Inclusion Criteria: 1. Documented symptomatic lone paroxysmal or persistent atrial fibrillation, which either convert spontaneously or can be terminated with antiarrhythmic drugs or by an electrical cardioversion. 2. The patient had a least one episode of persistent atrial fibrillation or three episodes of paroxysmal atrial fibrillation during the last three months. 3. Duration present episode persistent atrial fibrillation less then one year. 4. The patient has been treated with at least two different antiarrhythmic drugs (class I-IV) of which at least one belongs to class I or III. 5. The patient will sign and date the written informed consent prior to study participation. Exclusion Criteria: 1. Age \<18 and \>76 years. 2. Contraindications for oral anticoagulation. 3. Signs of sick sinus syndrome or AV conduction disturbances (i.e. symptomatic bradycardia or asystole \> 3 seconds or escape rate \< 40 beats per minute in awake symptom-free patients). 4. Permanent atrial fibrillation defined as atrial fibrillation continuously present and not convertible to sinus rhythm by an electrical cardioversion or antiarrhythmic drugs. 5. Previous transvenous pulmonary vein isolation, Maze surgery, or other cardiac surgery. 6. Heart failure defined as NYHA class III-IV heart failure. 7. Previously implanted intracardiac device or has current or foreseen pacemaker, internal cardioverter defibrillator (ICD) and/ or cardiac resynchronization therapy. 8. Clinically relevant valvular heart disease. 9. Coronary artery disease or an old myocardial infarction 10. Acute or chronic infection. 11. Untreated clinical hypo- or hyperthyroidism or \< 3 months euthyroidism. 12. Uncontrolled hypertension, defined as a systolic blood pressure \> 160 mm Hg and/or a diastolic blood pressure \> 95 mm Hg (anti-hypertensive treatment is allowed). 13. The patient has a concurrent medical condition (i.e. alcohol or drug abuse or a severe progressive extracardiac disease) or is unlikely to comply with the protocol.