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Atypical atrial flutter represents a large variety of macroreentrant atrial tachycardias utilizing flutter circuits in both the right and the left atrium. The combined use of 3D mapping and entrainment pacing provides insight into the course of the reentrant circuit(s) and facilitates the identification of the critical isthmus(es) as potential ablation targets. Thus, atypical atrial flutter has become amenable to catheter ablation with remarkable improvement in the acute and long-term efficacy of this therapy for this macroreentrant atrial arrhythmia.

AF differs from all other arrhythmias treated with catheter ablation in several aspects. There are multiple methods and techniques to ablate AF based on specific electrophysiologic features of this intriguing arrhythmia. The possible benefit of each approach must be judged on reported success rates (which sometimes might be too enthusiastic or based on incomplete follow-up data) as well as possible complications. It is still unclear which ablation approach offers the best results, but it is slowly emerging that the isolation of pulmonary veins seems to offer reasonable and reproducible curing rates in paroxysmal AF. For persistent and chronic AF (and to increase success rates in paroxysmal AF), a combination of several approaches seems to be reasonable. It is almost impossible to predict future directions of AF ablation, since this is a very fast evolving field with a multitude of theoretical and practical approaches currently under investigation.