In this case series we describe the anaesthetic management of atrial ablation for arrhythmia in three post heart transplant patients. These patients provide a unique challenge to the anaesthesiologist, as heart physiology, end organs effects, procedural related factors should all be part of the specific anaesthetic plan tailored for each patient individually. The different anaesthetic techniques applied, and procedure related complications are evaluated. Anaesthetic management, procedural related difficulties, pharmacologic aspects, and possible associated complications are reviewed.