Ventricular Tachycardia Ablation: Past, Present, and Future Perspectives

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Implantable cardioverter-defibrillators improve survival but can reduce quality of life due to therapies.
• Ventricular tachycardia (VT) ablation aims to prevent recurrent arrhythmias and associated adverse events.

Purpose of the Study:

• To review current VT ablation techniques, recommendations, and emerging technologies.
• To identify unmet needs and future research directions in VT ablation.

Main Methods:

• Percutaneous catheter-based ablation (endocardial or epicardial) guided by mapping techniques (activation, entrainment, pace, substrate).
• Review of current recommendations based on observational and prospective studies, primarily in ischemic heart disease.

Main Results:

• VT ablation is typically reserved for patients refractory to antiarrhythmic drugs.
• Limited prospective data exists on long-term outcomes, especially in non-ischemic cardiomyopathy.
• Emerging technologies and alternative ablation methods show promise but require further validation.

Conclusions:

• VT ablation is a crucial therapy, but patient referral is often late, limiting research.
• Future research should focus on survival benefit, non-ischemic cases, and intramural ablation strategies.
• Novel technologies like pulsed field electroporation and stereotactic radiotherapy warrant comparative studies against standard radiofrequency ablation.