Ablation Methods and Catheter Settings for Ventricular Tachycardia Ablation: A Bench to Bedside Review: Part 2

Catheter ablation remains a cornerstone in the treatment of ventricular tachycardia (VT) in structural heart disease. Part 1 of this review focused on the principles and technical aspects of radiofrequency (RF) ablation. Part 2 explores alternative strategies designed to overcome the limitations of conventional RF, in particular, achieving transmurality in complex or deep intramuscular substrates. We critically evaluate the mechanisms, evidence and clinical applications of bipolar RF ablation, pulsed-field ablation (PFA), ultra-low-temperature cryoablation (ULTC) and venous ethanol and needle ablation. Despite the rapid expansion ofthe technological armamentarium, current clinical evidence remains limited. The data supporting long-term safety and durability are predominantly based on preclinical and small observational studies. We advocate for continued investigation into these specialised techniques to provide a more tailored, patient-specific approach to VT management.