Boersma LVA and associates [Atrial Fibrillation Catheter Ablation Versus Surgical Ablation Treatment (FAST) / Clinical Perspective : A 2-Center Randomized Clinical Trial. Circulation. 2012;125:23-30] randomized drug refractory atrial fibrillation with left atrial enlargement and hypertension as well as those with failed prior attempts at catheter ablation to either surgical ablation or catheter ablation. Two thirds of the cases had failed catheter ablation earlier. The catheter ablation for the study included linear antral pulmonary vein isolation and additional ablation lines if needed. Surgical isolation included bipolar radiofrequency isolation of pulmonary veins on both sides, ablation of ganglionated plexi and excision of left atrial appendage with optional additional lines. Freedom from atrial arrhythmia was more with surgical ablation of 65.5% vs 36.5% with catheter ablation, at tweleve months follow up. Procedural complications were more in the surgical group (34.4 percent vs 15.9 percent).