The role of catheter ablation for ventricular tachycardia in patients with ischemic heart disease

PURPOSE OF REVIEW: Catheter ablation has evolved remarkably over the last 2 decades, bringing nonpharmacologic therapy to complex arrhythmias like atrial fibrillation and scar-related ventricular tachycardia. As our therapeutic options have increased for patients with ventricular tachycardia, choosing the right therapy for the right patient has become more complex. Ablation carries acute and perhaps longer-term procedural risk and variable success, whereas drug therapy likewise is limited by both side-effects and efficacy. RECENT FINDINGS: Early randomized trials of catheter ablation for ventricular tachycardia and multicenter experiences have recently been published, and further studies are underway to define the appropriate application of this therapy. Randomized trials have demonstrated that catheter ablation can reduce ventricular tachycardia episodes with relatively low risk. Multicenter experience has demonstrated a moderate risk of serious procedural adverse events in this very sick population, but ablation has never been compared directly with antiarrhythmic drug therapy. SUMMARY: There is still little evidence to clarify the relative merits of antiarrhythmic drug therapy in comparison with ablation. The optimal role of either therapy will remain uncertain until the completion of trials currently in progress. Until further evidence is available, most clinicians advocate first-line antiarrhythmic drug therapy, and reserve catheter ablation for when this fails or is not tolerated.