Introduction: Atrial fibrillation is the most common arrhythmia in the United States, yet currently, there are no curative options for patients. The aim of this study was to compare the efficacy of commonly performed invasive procedures in keeping patients in normal sinus rhythm. Methods and Results: A retrospective chart review was performed on all patients who underwent primary radiofrequency catheter ablation, the Complete Cox-maze, or the hybrid maze at OSF Saint Anthony Medical Center between January 2010 and December 2013 (n=140). Patients were followed-up for two years, with the primary outcome of the study being time until recurrence of their arrhythmia. Immediately post-procedure, recurrence rates did not differ between the three groups (p = 0.28). At all follow-up points thereafter, however, differences in procedural efficacy between surgical and catheter therapy remained highly significant (p < 0.001). At 2 years, 20.3% of the catheter ablation patients were in normal sinus rhythm, when compared to 57.9% of hybrid maze and 72.7% the complete Cox-maze groups. A difference in major complication rates was noted (p = 0.04), with the complete Cox-maze having a 17.4%, the hybrid having 22.7%, and the catheter ablation group having 5.6%. Conclusions: This study was unable to detect differences in the efficacy rates of the surgical procedures, however they were both superior to catheter ablation. Although the hybrid approach is considered minimally invasive, complication rates were similar to those of the complete Cox-maze. Catheter ablation was the safest procedure, and since evidence of reduced mortality after the use of aggressive rhythm therapy is lacking, the results suggest that hybrid surgery for atrial fibrillation should be used after the failure of more conservative measures.