Global Advances in Ventricular Tachycardia Ablation

Ventricular tachycardia (VT) is a potentially life-threatening arrhythmia associated with substantial morbidity and mortality, particularly in patients with structural heart disease. Over the past several decades, the management of VT has evolved significantly with the development of catheter-based and noninvasive ablation strategies aimed at eliminating arrhythmogenic myocardial substrates. This review provides a comprehensive overview of global advances in VT ablation, highlighting historical foundations, current therapeutic modalities, and emerging technologies shaping the future of ventricular arrhythmia (VA) management. Radiofrequency ablation remains the cornerstone of VT ablation and has undergone substantial technological refinement through innovations such as irrigated-tip catheters, high-density electroanatomic mapping, contact force sensing, and strategies for achieving deeper myocardial lesions. Alternative catheter-based energy modalities, including cryoablation and the emerging nonthermal technique of pulsed field ablation, provide additional therapeutic options with distinct mechanisms of action and safety profiles. In parallel, procedural advancements such as remote magnetic navigation have improved catheter stability and access to complex ventricular substrates. Beyond traditional catheter ablation, the therapeutic landscape has expanded to include neuromodulatory approaches targeting the cardiac autonomic nervous system, including thoracic epidural anesthesia, stellate ganglion blockade, cardiac sympathetic denervation, and renal denervation. These strategies play an important role in the management of refractory VAs and electrical storm. Furthermore, stereotactic body radiation therapy has emerged as a promising noninvasive treatment for patients with VT who are not candidates for or have failed catheter-based interventions. Additional investigational technologies including laser ablation, microwave ablation, and high-intensity focused ultrasound have been explored in preclinical and limited clinical settings but remain experimental in the context of VT management. Collectively, these evolving technologies underscore the increasingly multimodal approach required to treat complex VAs. In conclusion, VT ablation has progressed from early surgical and direct-current approaches to a sophisticated field incorporating advanced catheter techniques, neuromodulation, robotic navigation, and noninvasive therapies. Continued technological innovation, improved substrate characterization, and integration of emerging tools such as artificial intelligence are expected to further enhance procedural efficacy and patient outcomes. Individualized treatment strategies tailored to patient-specific arrhythmogenic substrates and clinical characteristics remain central to optimizing the management of VT.