Catheter ablation of ventricular fibrillation triggers and electrical storm

Ventricular fibrillation (VF) and electrical storm remain challenging conditions to manage despite the availability of various treatment modalities. Insertion of an implantable cardioverter defibrillator (ICD) remains the gold standard method for lowering the risk of sudden cardiac death in patients deemed to be at greatest risk of ventricular arrhythmias. However, ICDs do not alter the underlying substrate responsible for the arrhythmic events and a significant proportion of patients with ICDs may experience VF storm which may be life threatening and difficult to control with medication. Catheter ablation (CA) of the triggers or abnormal electrical substrate responsible for VF storm is an important treatment option in rare cases. In this article, we present an overview of the current theories underlying the mechanisms of VF and discuss how the technique of CA may be used to treat the triggers of VF and electrical storm. We review the literature on outcomes in patients who have undergone CA for VF in a variety of different settings, including those with structural heart disease and structurally normal hearts (e.g. patients with inherited arrhythmogenic diseases and idiopathic VF) and discuss the future directions in this field.