Current Status and Future Directions of Ventricular Arrhythmia Ablation

Abstract

Ventricular tachycardia (VT) catheter ablation has evolved over the past decade, allowing effective treatment of haemodynamically unstable and epicardial VTs in patients with structural heart disease previously not amenable to ablation. Catheter ablation reduces VT recurrences and thereby implantable cardioverter–defibrillator (ICD) shocks in 67–75% of patients, with a low incidence of procedure-related complications when performed in highly experienced centres. It can be life-saving in patients with electrical storm. Early use of ablation can be considered in selected patients who receive an ICD as an alternative to drug therapy provided that the procedure can be performed safely. Although acute results are promising, outcomes over the long-term are less favourable. An improved understanding of the VT substrate is mandatory for further advancement of a substrate-based ablation approach. Pre-procedural and intra-procedural imaging are likely to contribute to this. Whether catheter ablation will become first-line treatment for VT in structural heart disease and ultimately allow ICD implantation to be avoided in selected patients needs further evaluation.