Mayo Clinic electrophysiologists Paul A. Friedman, M.D., Fred Kusumoto, M.D., and Komandoor Srivathsan, M.D., discuss the Mayo Clinic approach to complex cardiac ablation therapy. The physicians discuss advances in mapping systems and intra-cardiac echocardiography technology to identify the specific cause of arrhythmias. The Mayo Clinic strategy includes mapping and then remapping to identify all arrhythmogenic substrate to effectively eliminate arrhythmias and minimize recurrences. Their approach also includes a lengthy in-procedure assessment to establish that the line of block is complete, minimizing the likelihood for repeat procedures. Today’s advances in sophisticated mapping technology also allows a much higher success rate in arrhythmia cases, including those which in the past were thought to be untreatable.