Internal and Surgical Ablations of Ventricular Arrhythmia and Bundle Branch Reentry Ventricular Tachycardia

Catheter ablation is a crucial therapeutic approach for managing ventricular arrhythmias (VAs), offered improved outcomes over the last few decades. The strategy’s efficacy and safety have seen consistent enhancements, benefiting patients both with and without structural heart disease. Combining endocardial and epicardial ablation has proven valuable, particularly in nonischemic cardiomyopathy, myocardial infarction, arrhythmogenic right ventricular cardiomyopathy, and certain epicardially originating focal VAs. However, despite these advancements, some VAs remain refractory, leading to life-threatening electrical storms and increased mortality rates. Surgical epicardial ablation has emerged as a promising alternative for managing such challenging cases. Bundle branch reentrant ventricular tachycardia (VT), a specific form of sustained monomorphic VT, involves a reentry circuit comprising the distal His-Purkinje system, left and right bundle branches, and the proximal ventricular septum. This review underscores the significance of comprehending the underlying substrate in VAs necessitating internal and surgical ablation, particularly in the context of bundle branch reentrant VT. The discussion encompasses mapping strategies, clinical prognosis, and the identification of optimal ablation techniques. Through this comprehensive examination, clinicians can better navigate the complexities of VA management, ultimately improving patient outcomes.