Catheter Ablation of Ventricular Tachycardia in Patients with Structural Heart Disease

Radiofrequency catheter ablation has revolutionized therapy of most forms of supraventricular tachycardia and ventricular tachycardia in the absence of structural heart disease by providing arrhythmia cure in almost 90% of patients. However, this treatment has not been nearly as successful in patients with ventricular tachycardia in the setting of structural heart disease, because of a number of factors. Some of these limitations are technical (imprecise mapping tools, multiple regions requiring ablation) although others are patient-related (hemodynamic instability during arrhythmia, progression of disease process). Because of these and other factors, the majority of patients in this group are treated with implantable defibrillators. Ablative therapy has an adjunctive role in their management, mainly to decrease the frequency of device therapy (particularly shocks). This review will discuss mapping and ablation techniques as well as patient selection and evaluation for this procedure.