Key result
Recent advances in substrate ablation and high-density mapping have improved the ability to selectively target the myocardial scar responsible for ventricular tachycardia while in sinus rhythm.
Recent advances in substrate ablation strategies and high-density mapping technologies have improved the targeting of arrhythmogenic scars in sinus rhythm for patients with ventricular tachycardia and structural heart disease.
May support scar-targeted VT ablation in sinus rhythm; leaves open need for randomized outcome trials.
PURPOSE OF REVIEW: Ablation of ventricular tachycardia in structural heart disease has evolved to include techniques to ablate the myocardial substrate in sinus rhythm for ventricular tachycardias that are noninducible or hemodynamically unstable. The intricacies of the complex functional and fixed components of the myocardial scar involved in the arrhythmic mechanisms require careful consideration in identifying targets for substrate ablation identified in sinus rhythm. RECENT FINDINGS: The substrate ablation approach referred to as 'scar homogenization' aims to thoroughly abolish any abnormal electrical activity inside the scar. However, this extensive approach may target bystander abnormal activity that is not necessarily related to arrhythmias. Recently, different substrate ablation strategies have been developed to more selectively target areas of the scar responsible for ventricular tachycardia. New technologies have also been introduced to provide offline analysis of the electroanatomical substrate, and to improve high-density mapping of the myocardial scar. SUMMARY: Recent advances have improved the ability to ablate ventricular tachycardia using techniques that allow targeting the responsible myocardial substrate while in sinus rhythm. Further research using higher-density mapping with more sophisticated online and offline analysis will aid in the assessment of the complex arrhythmogenicity of the scar and improve efficacy of ventricular tachycardia ablation.
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Proietti et al. (2015) conducted a review in Ventricular tachycardia associated with structural heart disease. Substrate ablation in sinus rhythm was evaluated. Recent advances in substrate ablation and high-density mapping have improved the ability to selectively target the myocardial scar responsible for ventricular tachycardia while in sinus rhythm.
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