Post-surgical arrhythmias include a wide range of arrhythmias occurring late after cardiac surgery and represent a complex substrate for catheter ablation either because of extended scar and remodeling or because of limited access to the area of interest. Novel image integration and ablation tools have made the catheter ablation in this population both feasible and successful. We review a structured approach to catheter ablation of post-surgical atrial arrhythmias in various patient cohorts including the most common congenital heart defects.