30. Stepwise Approach to Management of Atrial Arrhythmias after Catheter Ablation of Atrial Fibrillation

  1. Mohammad Shenasa MD2,
  2. Gerhard Hindricks MD3,
  3. Martin Borggrefe MD4,
  4. Günter Breithardt MD5 and
  5. Mark E. Josephson MD6
  1. Borislav Dinov,
  2. Arash Arya and
  3. Gerhard Hindricks

Published Online: 18 DEC 2012

DOI: 10.1002/9781118481585.ch30

Cardiac Mapping, Fourth Edition

Cardiac Mapping, Fourth Edition

How to Cite

Dinov, B., Arya, A. and Hindricks, G. (2013) Stepwise Approach to Management of Atrial Arrhythmias after Catheter Ablation of Atrial Fibrillation, in Cardiac Mapping, Fourth Edition (eds M. Shenasa, G. Hindricks, M. Borggrefe, G. Breithardt and M. E. Josephson), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781118481585.ch30

Editor Information

  1. 2

    Attending Physician, Department of Cardiovascular Services, O'Connor Hospital, Heart & Rhythm Medical Group, San Jose, California, USA

  2. 3

    Professor of Medicine (Cardiology), University Leipzig, Heart Center, Director, Department of Electrophysiology, Leipzig, Germany

  3. 4

    Professor of Medicine (Cardiology), Head, Department of Cardiology, Angiology and Pneumology, University Medical Center, Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany

  4. 5

    Professor Emeritus of Medicine and Cardiology, Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany

  5. 6

    Chief, Cardiovascular Medicine Division, Director, Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Beth Israel Deaconess Medical Center, Herman C. Dana Professor of Medicine, Harvard Medical School, Boston, Massachusetts, USA

Author Information

  1. Department of Electrophysiology, University of Leipzig, Heart Center, Leipzig, Germany

Publication History

  1. Published Online: 18 DEC 2012
  2. Published Print: 10 JAN 2013

ISBN Information

Print ISBN: 9780470670460

Online ISBN: 9781118481585



  • pulmonary vein;
  • atrial ablation;
  • atrial fibrillation;
  • atrial tachycardias;
  • complex fractionated atrial electrograms;
  • entrainment mapping;
  • 3D mapping systems


Pulmonary vein (PV) isolation and different left atrial ablation strategies proved to be curative for patients with paroxysmal and persistent (AF). However the ablation lesions in the left atrium could lead to iatrogenic left atrial tachycardias (AT) which is observed in up to 40% of patients with previous AF ablation. Nearly one-third of the recurrent AT after AF ablation disappear spontaneously, however, the majority of these patients will need a repeated ablation procedure as antiarrhythmic medications tend to be less effective in such patients. Understanding the previously ablated lines is of critical importance for the subsequent ablation strategy. Mapping and re-isolation of all PVs should be the first step approaching the left ATs. In this chapter we describe a deductive stepwise strategy which will help to successfully ablate these ATs with favorable long-term results.