Cardiac arrhythmias, particularly atrial fibrillation, represent a major cardiovascular health problem due to their high prevalence and association with thromboembolic events, heart failure, and increased mortality. In this context, in addition to pharmacological treatment and catheter ablation, surgical management plays a relevant role, especially when combined with structural cardiac procedures. The Cox-Maze surgery has become the main surgical strategy for rhythm control, evolving from the traditional “cut-and-sew” technique to the Cox-Maze IV procedure, based on radiofrequency and cryoablation. The aim of this study was to analyze the role of the Cox-Maze procedure in the surgical treatment of cardiac arrhythmias, addressing its technical foundations, indications, and outcomes. This is a narrative literature review based on guidelines and contemporary studies. The findings demonstrate high efficacy in maintaining sinus rhythm and its relevance in concomitant cardiac surgeries. It is concluded that the Cox-Maze procedure remains the gold standard in the surgical treatment of atrial fibrillation, requiring careful patient selection and technical expertise.