Background It is unclear whether the effect of video-assisted thoracoscopic surgery ablation is better than catheter ablation on paroxysmal atrial fibrillation (PAF) or not.This study aimed to compare the effects of catheter ablation and video-assisted thoracoscopic surgery ablation on PAF.Methods From March 2008 to March 2012,138 consecutive patients with PAF were randomly assigned to receive either video-assisted thoracoscopic surgery ablation (thoracoscopy group,n=66) or the traditional catheter ablation (catheter group,n=72).Results No patient died during the study and all were successfully followed and included in analysis.There were no significant differences in clinical and echocardiographic characteristics between the two groups.All patients were evaluated at 1 week,1 month,3 months,6 months,and 12 months after discharge by physical examination and related laboratory tests.Preoperative left atrium dimensions (LADs) of the recurrent AF were (47±4) mm in the thoracoscopy group and (46±8) mm in the catheter group,whereas the LADs were (40±5) and (39±9) mm,respectively,in non-recurrent PAF.Conclusions The short-term outcome of video-assisted thoracoscopic surgery ablation is safe and effective; and the indications are wider than those for catheter ablation.The larger left atrium diameter is related to the recurrence of atrial fibrillation.