Atrial fibrillation in patients with isolated, therapy resistant, chronic or paroxysmal atrial fibrillation (AF) or AF in combination with additional valvular and non-valvular cardiac pathology can be surgically treated by different techniques. Unipolar high frequency, cryotherapy and microwave energy is a curative approach for the treatment of the left atrium for AF. The postoperative mortality and morbidity rate is comparable to other cardiac surgery procedures. It is a technically less challenging procedure as compared to the MAZE procedure and can be applied using a minimally invasive approach. Alternative techniques such as new cryotechnologies, laser application and bipolar high frequency energy need to be evaluated for effectiveness and safety.