Advances in Mapping and Ablation of Ventricular Fibrillation

Purpose of review Catheter ablation of ventricular fibrillation (VF) is challenging due to the difficulty in interpreting fibrillatory electrograms and the complete hemodynamic collapse with VF precluding detailed mapping. Successful ablation can be performed by eliminating triggers of VF. We review the contemporary advances in VF ablation, especially targeting the substrate for VF. Recent findings Strategies to map and eliminate the substrate for VF can be applied generally, even in the absence of a reliable trigger. VF substrate can be mapped during sinus rhythm with signature low-voltage, fractionated, and late electrograms. Such substrate can be harbored within regions of scar in structural heart disease, or localized as epicardial microstructural abnormality in Brugada syndrome, inferolateral J-wave syndrome, and unexplained VF. Ablation of such substrate is an effective antiarrhythmic strategy. Furthermore, innovations in expeditious panoramic mapping techniques have generated interest in directly mapping and ablating drivers that sustain VF. Advances in understanding of ablation targets and innovations in mapping techniques are enabling successful ablation of VF in the electrophysiology laboratory. Beyond ablation of VF triggers in a subset of patients, progress is being made in ablating the substrate for VF in patients afflicted by this lethal arrhythmia.