[Atrial tachycardia after previous ablation-right atrial, left atrial, biatrial]

Catheter-assisted ablation of supraventricular tachycardia, especially of atrial fibrillation, often results in atrial tachycardia (AT) in the further course. ATs are favored by incomplete linear lesions, scarring of the atria or persistent pulmonary vein connections, and vary in incidence depending on the type of the preceding procedure.

This article discusses different forms of postablation AT in terms of diagnosis, treatment options, and perspectives for prevention and effective treatment.

Overview-based review of the literature and case-based experiences from our own center on incidence, mapping methods, and ablation strategies as well as emerging technologies.

The reported incidence of postablation ATs varies widely (4-36%), depending on patient selection and procedural complexity. Invasive diagnostics are mainly based on ultra-high-resolution mapping methods, while classical electrophysiological maneuvers are less reliable in this patient population. The therapy of choice is reablation, as drug options are less effective. Depending on the mechanism of AT, focal or linear ablation strategies are preferred, with variable success and more frequent recurrences than with initial ablations. Newer catheter designs and improved lesion control are gaining importance. A technically precise and completely transmural initial ablation remains a central predictor of long-term rhythm stability. Multimodal approaches and individualized strategies are key to the future to sustainably reduce the incidence and recurrence of postablation AT.