Troubleshooting to avoid failed ablation

Successful therapy for arrhythmias after ablation starts with proper case selection, preprocedural planning, selection of case-specific tools, and an arrhythmia-specific strategy. This chapter discusses a general approach to optimizing ablation success followed by specific arrhythmia scenarios. Both objective and subjective assessments should be considered before and after ablation to measure the outcomes of the ablation. A full list of potential diagnoses and exclusions should be created before the procedure for adequate procedural planning. The chapter presents some common reasons for failed ablation for arrhythmia. It explains common pitfalls in utilization of a three-dimensional electroanatomical mapping system and troubleshooting to avoid these pitfalls. In general, either electroanatomical or entrainment mapping may be used for evaluation of a reentrant atrial or ventricular arrhythmia before ablation. At the time of planning an ablation strategy or counseling the patient, it is important to consider the possibility of creating a new substrate for another arrhythmia.