Ventricular tachycardia ablation: indications and techniques

Over the last decades indications have broadened and techniques have been developed resulting in an increasing use of catheter ablation for different types of ventricular tachycardia (VT). Due to the high ablation success for non scar-related ventricular arrhythmia (VA) catheter ablation has become a first line therapy for symptomatic idiopathic VA or VA presumed to cause ventricular dysfunction. For the ablation of scar-related VTs individual patient factors and operator experience play an important role in risk-benefit considerations. However, the development of substrate based techniques, irrigated tip catheter ablation and the introduction of a percutaneous epicardial approach in selected patients has greatly enhanced the treatment of VTs in patients with structural heart disease. Understanding of the VT substrate in different diseases and individual patients is important for mapping and ablation. Advances in substrate imaging technologies and their integration during ablation procedures may provide more insights into the substrates and may guide VT ablation in the future. The distinction between scar-related and non scar-related VT is relevant because it may affect treatment and prognosis. Distinction between these entities may be facilitated by identification of the VT substrate during catheter mapping. Failure of catheter ablation is often due to the anatomical localization of the arrhythmic source or reentry circuit. However, evolving new catheter techniques and energy sources may overcome these limitations.