Long-term result of the maze operation is unknown. Anticoagulation therapy is controversial even after success of the maze operation. Between 1997 and 2008, 213 patients underwent the maze procedure. Atrial fibrillation (Af) was chronic in 151 patients and paroxysmal in 62. Concomitant mitral valve procedure were performed in 72%. Early mortality was 1.9%. By dismissal electrocardiography 157 patients (74%) wes free from Af. At the last follow-up (mean 38 +/- 30 months), late Af recurrence had occurred in 16 patients. Af recurrence had occurred within 1-year in 15 patients. Risk factors for late Af recurrence was left atrial dimension of 50 mm or greater (P<0.001). There was no difference in 5-year freedom from Af between the Cox maze procedure versions. Anticoagulation for patients with large left atrium is mandatory for 1-year after surgery.